An analysis by London School of Hygiene and Tropical Medicine researchers finds general room for improvement in the technical efficiency of HIV services, amid some signs that cost reductions are starting to be achieved.
Anna Vassall, Michelle Remme, and Mariana Siapka — LSHTM researchers and members of the RethinkHIV consortium — worked with Claudia B Maier and Karl L Dehne of UNAIDS on this UNAIDS-funded review, to synthesise the data available on costs, efficiency and economies of scale for the six basic programmatic activities of the UNAIDS Strategic Investment Framework.
Because of the interest from policy-makers in reducing the costs of HIV services, the researchers point to an urgent need to update and synthesize the data on the technical efficiency of HIV services. They note some “signs of recent improvements” in the costing of HIV services, with most of their main findings derived from studies conducted over the past five years.
The analysis, “Is there scope for cost savings and efficiency gains in HIV services? A systematic review of the evidence from low- and middle-income countries“, looks at optimising economies of scale (the reductions in cost that can be achieved when the volume of service provision is increased) and at economies of scope (the reductions in cost that can be achieved when one service is provided jointly with others).
Of the 82 empirical costing and efficiency studies that the authors examine, nine provide data on economies of scale. Scale explains much of the variation in the costs of several HIV services, particularly those of targeted HIV prevention for key populations and HIV testing and treatment.
The authors find some evidence of economies of scope from integrating HIV counselling and testing services with other services. Cost efficiency may also be improved by reducing input prices, task shifting and improving service user retention.
The review concludes that there is a need for large-scale costing studies that cover the full range of HIV services. Empirical costing studies above the service level are also required, to provide insights into approaches for optimising programme costs. And experimental studies – especially on planning and management capacity, utilisation of human resources, financial and information systems, demand generation and service integration – could help to improve efficiency.
Image credit: Equality Michigan
RethinkHIV is a consortium of senior researchers from London School of Hygiene & Tropical Medicine, Imperial College London, Harvard School of Public Health, Centre for the Study of African Economies and Blavatnik School of Government at Oxford University.
The consortium will evaluate new evidence related to the costs, benefits, effects, fiscal implications, and developmental impacts of HIV interventions in sub-Saharan Africa, in order to maximise contributions to the fight against HIV there.
The aim of RethinkHIV is to find ways of creating, optimising, and sustaining fiscal space for domestic HIV investment, as well as exploring long-term, sustainable national and international financing mechanisms. RethinkHIV is funded by RUSH Foundation.