title: What is the cost of providing outpatient HIV counseling and testing and antiretroviral therapy services in selected public health facilities in Nigeria?
abstract: BACKGROUND
  Limited data on actual cost of providing HIV/AIDS services in Nigeria makes planning difficult. A study was conducted in 9 public health facilities supported by the Global HIV/AIDS Initiative Nigeria. The objective was to determine the cost of outpatient HIV Testing and Counseling (HTC) and antiretroviral therapy (ART) services per patient.
  
  
  METHODS
  Two tertiary and 7 secondary facilities were purposively selected across the six geopolitical regions. Facilities were distributed in urban and rural settings. Utilization and cost data for a 12-month period (January to December 2010) were analyzed. Cost elements included consumables, human resources, infrastructure, trainings, facility management, and Global HIV/AIDS Initiative Nigeria technical support. Total costs were apportioned based on percentage utilization by services, and unit costs were derived by dividing resource inputs by service outputs. Data were analyzed using Microsoft Excel 2003. A sensitivity analysis was also conducted for key assumptions.
  
  
  RESULTS
  Mean costs for HTC and ART were US $7.4 and US $209.0, respectively. Costs were higher in Northern facilities (US $6.9, US $250.8), compared with Southern ones (US $6.7, US $194.7); and in tertiary facilities ($18.5, $338.4), compared with secondary ones ($6.3, $204.9). Major cost drivers for HTC and ART were human resources--ranging from 62% to 50%, and ARV drugs--ranging from 54% to 31%, respectively.
  
  
  CONCLUSIONS
  Governments' ability to negotiate lower priced antiretroviral drugs will be central to reducing the cost of ART. Additionally, use of lower cadre staff to provide HTC will reduce costs and improves efficiency.
authors: Health Policy and Systems Management Department, Family Health International, Abuja, Nigeria. haliyu@ghain.org
authors: Husaina Bello
authors: HB
authors: Aliyu
authors: Nkata Nwani
authors: NN
authors: Chuku
authors: Abimbola
authors: A
authors: Kola-Jebutu
authors: Zubaida
authors: Z
authors: Abubakar
authors: Kwasi
authors: K
authors: Torpey
authors: Otto Nzapfurundi
authors: ON
authors: Chabikuli
mesh_terms: D000553:Ambulatory Care / Q000191:economics* / Q000379:methods; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000191:economics*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics / Q000379:methods; D003376:Counseling / Q000191:economics* / Q000379:methods; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D009549:Nigeria; D010045:Outpatients; D011635:Public Health Administration / Q000191:economics* / Q000379:methods; D012189:Retrospective Studies
chemical_list: D044966:Anti-Retroviral Agents