title: The costs of scaling up HIV prevention for high risk groups: lessons learned from the Avahan Programme in India.
abstract: OBJECTIVE
  The study objective is to measure, analyse costs of scaling up HIV prevention for high-risk groups in India, in order to assist the design of future HIV prevention programmes in South Asia and beyond.
  
  
  METHODS
  Prospective costing study.
  
  
  METHODS
  This study is one of the most comprehensive studies of the costs of HIV prevention for high-risk groups to date in both its scope and size. HIV prevention included outreach, sexually transmitted infections (STI) services, condom provision, expertise enhancement, community mobilisation and enabling environment activities. Economic costs were collected from 138 non-government organisations (NGOs) in 64 districts, four state level lead implementing partners (SLPs), and the national programme level (Bill and Melinda Gates Foundation (BMGF)) office over four years using a top down costing approach, presented in US$ 2011.
  
  
  RESULTS
  Mean total unit costs (2004-08) per person reached at least once a year and per monthly contact were US$ 235(56-1864) and US$ 82(12-969) respectively. 35% of the cost was incurred by NGOs, 30% at the state level SLP and 35% at the national programme level. The proportion of total costs by activity were 34% for expertise enhancement, 37% for programme management (including support and supervision), 22% for core HIV prevention activities (outreach and STI services) and 7% for community mobilisation and enabling environment activities. Total unit cost per person reached fell sharply as the programme expanded due to declining unit costs above the service level (from US$ 477 per person reached in 2004 to US$ 145 per person reached in 2008). At the service level also unit costs decreased slightly over time from US$ 68 to US$ 64 per person reached.
  
  
  CONCLUSIONS
  Scaling up HIV prevention for high risk groups requires significant investment in expertise enhancement and programme administration. However, unit costs decreased with programme expansion in spite of an increase in the scope of activities.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom; St John's Research Institute, Bangalore, India.
authors.forename: Sudhashree
authors.initials: S
authors.lastname: Chandrashekar
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Lorna
authors.initials: L
authors.lastname: Guinness
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom; Imperial College, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Pickles
authors.affiliation: Karnataka Health Promotion Trust, Bangalore, India.
authors.forename: Govindraj Y
authors.initials: GY
authors.lastname: Shetty
authors.affiliation: URESP, Centre de recherchedu CHU de Quebec, Quebec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Alary
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Vickerman
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Anna
authors.initials: A
authors.lastname: Vassall
mesh_terms: D003140:Communicable Disease Control / Q000191:economics*; D003365:Costs and Cost Analysis; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D007194:India; D008297:Male; D015397:Program Evaluation; D012306:Risk; D018401:Sample Size; D060386:Sex Workers / Q000706:statistics & numerical data; D013997:Time Factors