Public sector services for the prevention of mother-to-child transmission of HIV infection: a micro-costing survey in Namibia and Rwanda.
OBJECTIVE
To assess the costs associated with the provision of services for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus in two African countries.


METHODS
In 2009, the costs to health-care providers of providing comprehensive PMTCT services were assessed in 20 public health facilities in Namibia and Rwanda. Information on prices and on the total amount of each service provided was collected at the national level. The costs of maternal testing and counselling, male partner testing, CD4+ T-lymphocyte (CD4+ cell) counts, antiretroviral prophylaxis and treatment, community-based activities, contraception for 2 years postpartum and early infant diagnosis were estimated in United States dollars (US$).


RESULTS
The estimated costs to the providers of PMTCT, for each mother-infant pair, were US$202.75-1029.55 in Namibia and US$94.14-342.35 in Rwanda. These costs varied with the drug regimen employed. At 2009 coverage levels, the maximal estimates of the national costs of PMTCT were US$3.15 million in Namibia and US$7.04 million in Rwanda (or < US$0.75 per capita in both countries). Adult testing and counselling accounted for the highest proportions of the national costs (37% and 74% in Namibia and Rwanda, respectively), followed by management and supervision. Treatment and prophylaxis accounted for less than 20% of the costs of PMTCT in both study countries.


CONCLUSIONS
The costs involved in the PMTCT of HIV varied widely between study countries and in accordance with the protocols used. However, since per-capita costs were relatively low, the scaling up of PMTCT services in Namibia and Rwanda should be possible.
Université de Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, 146 Rue Léo Saignat, 33076 Bordeaux, France .
Hapsatou
H
Touré
Martine
M
Audibert
Patricia
P
Doughty
Landry
L
Tsague
Placidie
P
Mugwaneza
Elevanie
E
Nyankesha
Steve
S
Okokwu
Cedric
C
Limbo
Makan
M
Coulibaly
Virginie
V
Ettiègne-Traoré
Chewe
C
Luo
Francois
F
Dabis
D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009276:Namibia; D011247:Pregnancy; D011314:Preventive Health Services / Q000191:economics*; D017150:Public Sector; D012432:Rwanda