title: Costs along the service cascades for HIV testing and counselling and prevention of mother-to-child transmission.
abstract: We estimate facility-level average annual costs per client along the HIV testing and counselling (HTC) and prevention of mother-to-child transmission (PMTCT) service cascades.
  
  
  
  Data collected covered the period 2011-2012 in 230 HTC and 212 PMTCT facilities in Kenya, Rwanda, South Africa, and Zambia.
  
  
  
  Input quantities and unit prices were collected, as were output data. Annual economic costs were estimated from the service providers' perspective using micro-costing. Average annual costs per client in 2013 United States dollars (US$) were estimated along the service cascades.
  
  
  
  For HTC, average cost per client tested ranged from US$5 (SD US$7) in Rwanda to US$31 (SD US$24) in South Africa, whereas average cost per client diagnosed as HIV-positive ranged from US$122 (SD US$119) in Zambia to US$1367 (SD US$2093) in Rwanda. For PMTCT, average cost per client tested ranged from US$18 (SD US$20) in Rwanda to US$89 (SD US$56) in South Africa; average cost per client diagnosed as HIV-positive ranged from US$567 (SD US$417) in Zambia to US$2021 (SD US$3210) in Rwanda; average cost per client on antiretroviral prophylaxis ranged from US$704 (SD US$610) in South Africa to US$2314 (SD US$3204) in Rwanda; and average cost per infant on nevirapine ranged from US$888 (SD US$884) in South Africa to US$2359 (SD US$3257) in Rwanda.
  
  
  
  We found important differences in unit costs along the HTC and PMTCT service cascades within and between countries suggesting that more efficient delivery of these services is possible.
authors.affiliation: aNational Institute of Public Health (INSP), Division of Health Economics, Cuernavaca, Mexico bUNAIDS, Geneva, Switzerland cDivision of Economics, University of Zambia, Lusaka, Zambia dNational University of Rwanda, School of Public Health, Kigali, Rwanda eBrown University, Providence, Rhode Island, USA fPerinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa gRwanda Biomedical Center, Kigali, Rwanda hNortheastern University, Boston, Massachusetts, USA iUniversity of Nairobi, School of Public Health, Nairobi, Kenya.
authors.forename: Sergio
authors.initials: S
authors.lastname: Bautista-Arredondo
authors.forename: Sandra G
authors.initials: SG
authors.lastname: Sosa-Rubí
authors.forename: Marjorie
authors.initials: M
authors.lastname: Opuni
authors.forename: David
authors.initials: D
authors.lastname: Contreras-Loya
authors.forename: Ada
authors.initials: A
authors.lastname: Kwan
authors.forename: Claire
authors.initials: C
authors.lastname: Chaumont
authors.forename: Abson
authors.initials: A
authors.lastname: Chompolola
authors.forename: Jeanine
authors.initials: J
authors.lastname: Condo
authors.forename: Omar
authors.initials: O
authors.lastname: Galárraga
authors.forename: Neil
authors.initials: N
authors.lastname: Martinson
authors.forename: Felix
authors.initials: F
authors.lastname: Masiye
authors.forename: Sabin
authors.initials: S
authors.lastname: Nsanzimana
authors.forename: Ivan
authors.initials: I
authors.lastname: Ochoa-Moreno
authors.forename: Richard
authors.initials: R
authors.lastname: Wamai
authors.forename: Joseph
authors.initials: J
authors.lastname: Wang'ombe
mesh_terms: D000349:Africa; D003376:Counseling / Q000191:economics*; D003955:Diagnostic Tests, Routine / Q000191:economics*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control*; D017048:Health Care Costs; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000191:economics* / Q000517:prevention & control*; D008297:Male; D012189:Retrospective Studies