Costs along the HTC and PMTCT service cascades: findings from Kenya, Rwanda, South Africa, and Zambia

OBJECTIVE:: We estimate facility-level average annual cost per client along the HIV testing and counselling (HTC) and prevention of mother-to-child transmission (PMTCT) service cascades. DESIGN:: Data were collected from 2011–2013 in 230 HTC and 212 PMTCT facilities in Kenya, Rwanda, South Africa, and Zambia. METHODS:: 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 US$ were estimated along the service cascades. RESULTS:: 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$1,367 (SD US$2,093) 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$2,021 (SD US$3,210) in Rwanda; average cost per client on antiretroviral (ARV) prophylaxis ranged from US$704 (SD US$610) in South Africa to US$2,314 (SD US$3,204) in Rwanda; and average cost per infant on nevirapine (NVP) ranged from US$888 (SD US$884) in South Africa to US$2,359 (SD US$3,257) in Rwanda. CONCLUSIONS:: 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.