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Objective To evaluate resource allocation and costs associated with delivery of human Immunodeficiency virus (HIV) services In Uganda and the United Republic of Tanzania. Methods We used time-driven activity-based costing to determine the resources consumed and costs of providing five HIV services in Uganda and the United Republic of Tanzania: antiretroviral therapy (ART); HIV testing and counselling; prevention of mother-to-child transmission; voluntary male medical circumcision; and pre-exposure prophylaxis. Findings Country-based teams undertook time-driven activity-based costing with 1119 adults in Uganda and 886 adults in the United Republic of Tanzania. In Uganda, service delivery costs ranged from 8.18 United States dollars (US$) per visit for HIV testing and counselling to US$ 43.43 for ART (for clients in whom HIV was suppressed). In the United Republic of Tanzania, these costs ranged from US$ 3.67 per visit for HIV testing and counselling to US$ 28.00 for voluntary male medical circumcision. In both countries, consumables were the main cost driver, accounting for more than 60% of expenditure. Process maps showed that in both countries, registration, measurement of vital signs, consultation and medication dispensing were the steps that occurred most frequently for ART clients. Conclusion Establishing a rigorous, longitudinal system for tracking investments in HIV services that includes thousands of clients and numerous facilities is achievable in different settings with a high HIV burden. Consistent engagement of implementation partners and standardized training and data collection instruments proved essential for the success of these exercises. Objectif Analyser l'allocation des ressources et les couts lies a la fourniture de services de prise en charge du virus de l'immunodeficience humaine (VIH) en Ouganda et en Republique-Unie de Tanzanie. Methodes Nous avons utilise un systeme de calcul des couts par activite pilote par le temps (TDABC), pour identifier les ressources consommees et les couts engendres par cinq services de prise en charge du VIH en Ouganda et en Republique-Unie de Tanzanie: le traitement antiretroviral (TAR); le depistage du VIH et les conseils en la matiere; la prevention de la transmission de la mere a l'enfant; la pratique volontaire de la circoncision masculine medicalisee; et enfin, la prophylaxie preexposition. Resultats Des equipes deployees dans chaque pays ont mene un calcul des couts par activite pilote par le temps aupres de 1119 adultes en Ouganda et 886 adultes en Republique-Unie de Tanzanie. En Ouganda, les couts de prestation des services etaient compris entre 8,18 dollars americains (USD) par visite de depistage du VIH et de conseils en la matiere, et 43,43 USD pour un TAR (sur les patients chez qui la charge virale a ete supprimee). En Republique-Unie de Tanzanie, ces couts variaient entre 3,67 USD par visite de depistage du VIH et de conseils en la matiere a 28,00 USD pour la pratique volontaire de la circoncision masculine medicalisee. Dans les deux pays, les consommables representaient le principal facteur de cout, avec plus de 60% des depenses. Les schemas de procedure ont montre que, dans les deux pays, l'enregistrement, la mesure des signes vitaux, la consultation et l'administration du traitement constituaient les etapes les plus frequentes chez les patients faisant l'objet d'un TAR. Conclusion Il est possible d'etablir un dispositif longitudinal rigoureux pour suivre les investissements realises dans les services de prise en charge du VIH, qui inclut des milliers de patients et de nombreux etablissements dans differents endroits fortement touches par le VIH. Limplication constante des partenaires de mise en oeuvre et la standardisation des formations et instruments de collecte des donnees se sont revelees essentielles a la reussite de ces demarches. Objetivo Analizar la asignacion de recursos y los costes asociados a la prestacion de servicios por el virus de la inmunodeficiencia humana (VIH) en Uganda y en la Republica Unida de Tanzania. Metodos Utilizamos los costes basados en el tiempo invertido por actividad, con el fin de determinar los recursos consumidos y los costes de la prestacion de cinco servicios por VIH en Uganda y en la Republica Unida de Tanzania: terapia antirretroviral (TAR); pruebas y asesoramiento sobre el VIH; prevencion de la transmision de madre a hijo; circuncision medica masculina de caracter voluntario y profilaxis previa a la exposicion. Resultados Los equipos fundados en el pais se encargaron de analizar los costes basados en el tiempo invertido por actividad con 1119 adultos en Uganda y 886 adultos en la Republica Unida de Tanzania. En Uganda, los costes por la prestacion de servicios oscilaron entre 8,18 dolares estadounidenses (USD) por visita destinada a pruebas y asesoramiento sobre VIH, y 43,43 USD por TAR (para clientes en los que se habia erradicado el VIH). En la Republica Unida de Tanzania, estos costes estuvieron comprendidos entre 3,67 USD por visita destinada a pruebas y asesoramiento sobre VIH, y 28,00 USD por circuncision medica masculina de caracter voluntario. En ambos paises, los consumibles fueron los principales generadores de costes, representando mas del 60% del gasto. Los mapas de procesos mostraron que en ambos paises el registro, la medicion de las constantes vitales, asi como las consultas y la dispensacion de medicacion fueron los pasos que mas se repitieron entre los clientes con TAR. Conclusion Implantar un sistema riguroso y longitudinal para realizar un seguimiento de las inversiones en servicios por VIH, lo que engloba a miles de clientes y numerosas instalaciones, es algo que se puede lograr en aquellos centros con una elevada incidencia de VIH. Quedo demostrado que el compromiso constante de los socios encargados de la implementacion, asi como la existencia de instrumentos estandarizados de formacion y de recopilacion de datos resultaban esenciales para el exito de estos ejercicios., Introduction Despite evolving epidemiological trends, human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are still responsible for one of the largest disease burdens in sub-Saharan Africa. (1) In low-income [...]

The United States President's Emergency Plan for AIDS Relief (PEPFAR) has been credited with saving millions lives and helping to change the trajectory of the global human immunodeficiency virus (HIV) epidemic. This study assesses whether PEPFAR has had impacts beyond health by examining changes in five economic and educational outcomes in PEPFAR countries: the gross domestic product (GDP) per capita growth rate; the share of girls and share of boys, respectively, who are out of school; and female and male employment rates. We constructed a panel data set for 157 low- and middle-income countries between 1990 and 2018 to estimate the macroeconomic impacts of PEPFAR. Our PEPFAR group included 90 countries that had received PEPFAR support over the period. Our comparison group included 67 low- and middle-income countries that had not received any PEPFAR support or had received minimal PEPFAR support (<$1M or <$.05 per capita) between 2004 and 2018. We used differences in differences (DID) methods to estimate the program impacts on the five economic and educational outcome measures. This study finds that PEPFAR is associated with increases in the GDP per capita growth rate and educational outcomes. In some models, we find that PEPFAR is associated with reductions in male and female employment. However, these effects appear to be due to trends in the comparison group countries rather than programmatic impacts of PEPFAR. We show that these impacts are most pronounced in COP countries receiving the highest levels of PEPFAR investment. [ABSTRACT FROM AUTHOR]

Background: Previous research on the association between maternal HIV status and child mortality in sub–Saharan Africa was published between 2005–2011. Findings from these studies showed a higher child mortality risk among children born to HIV–positive mothers. While the population of women with disabilities is growing in developing countries, we found no research that examined the association between maternal disability in HIV–positive mothers, and child mortality in sub–Saharan Africa. This study examined the potential compounding effect of maternal disability and HIV status on child mortality in South Africa. Methods: We analyzed data for women age 15–49 years from South Africa, using the nationally representative 2016 South Africa Demographic and Health Survey. We estimated unadjusted and adjusted risk ratios of child mortality indicators by maternal disability and maternal HIV using modified Poisson regressions. Results: Children born to disabled mothers compared to their peers born to non-disabled mothers were at a higher risk for neonatal mortality (RR = 1.80, 95% CI:1.31–2.49), infant mortality (RR = 1.69, 95% CI:1.19–2.41), and under-five mortality (RR = 1.78, 95% CI:1.05–3.01). The joint risk of maternal disability and HIV-positive status on the selected child mortality indicators is compounded such that it is more than the sum of the risks from maternal disability or maternal HIV-positive status alone (RR = 3.97 vs. joint RR = 3.67 for neonatal mortality; RR = 3.57 vs. joint RR = 3.25 for infant mortality; RR = 6.44 vs. joint RR = 3.75 for under-five mortality). Conclusions: The findings suggest that children born to HIV-positive women with disabilities are at an exceptionally high risk of premature mortality. Established inequalities faced by women with disabilities may account for this increased risk. Given that maternal HIV and disability amplify each other's impact on child mortality, addressing disabled women's HIV-related needs and understanding the pathways and mechanisms contributing to these disparities is crucial. [ABSTRACT FROM AUTHOR]

The health profile of Bangladesh has improved remarkably, yet gaps in delivering quality health care remain. In response to the need for evidence to quantify resources for providing health services in Bangladesh, this study estimates unit costs of providing the essential services package (ESP) in the not-for-profit sector. This study used a stratified sampling approach to select 18 static clinics, which had fixed facilities, from 330 non-profit clinics under Smiling Sun network in Bangladesh. Costs were estimated from the providers' perspective, using both top-down and bottom-up methods, from July 2014 to June 2015. In total, there were 1115 observations (clients) for the 13 primary care services analysed. The estimated 2015 average costs per visit were: antenatal care ($7.03), postnatal care ($4.57), control of diarrheal diseases ($1.32), acute respiratory infection ($1.53), integrated management of child illness ($2.02), sexually transmitted infections ($4.70), reproductive tract infections ($3.56), tuberculosis ($41.65), limited curative care ($4.30), immunization ($2.23), family planning ($0.72), births by normal delivery ($29.45) and C-section ($114.83). Unit costs varied widely for each service, both between individual patients and among clinic level means. The coefficient of variation for the 13 services averaged 66%, implying potential inefficiencies. In addition, 32.9% of clients were not offered any lab test during the first antenatal visit. The unit cost of essential services differed by the type and location of clinics. Ultra clinics, on average, incurred 37% higher costs than vital (outpatient type) clinics, and urban clinics spent 40% more than rural clinics to deliver a unit of service. The study suggests that inefficiency and quality concerns exist in health service delivery in some facilities. Increasing the volume of clients through demand-side mechanisms and standardization of services would help address those concerns. Unit costs of services provide essential information for estimating resource needs for scaling up the ESPs. [ABSTRACT FROM AUTHOR]

Objective: In high HIV-burden countries like Uganda, financing and resource allocation for HIV services have rapidly evolved. This study aimed to employ time-driven activity-based costing (TDABC) to examine the allocation of resources and associated costs for HIV care throughout the country., Design: A cross-sectional study., Setting: This study was conducted at 31 health facilities throughout Uganda: 16 level III health centres, 10 level IV health centres and 5 district hospitals., Participants: 1119 persons receiving HIV services in 2020., Methods: We conducted TDABC to quantify costs, resource consumption and duration of service provision associated with antiretroviral therapy, prevention of mother-to-child transmission, HIV counselling and testing (HCT), voluntary medical male circumcision (VMMC) and pre-exposure prophylaxis. We also quantified disparities in resource consumption according to client-level and facility-level characteristics to examine equity. Fixed-effects multivariable regression analyses were employed to inspect factors associated with service costs and provider-client interaction time., Results: The mean cost of services ranged from US$8.18 per visit for HCT to US$32.28 for VMMC. In terms of disparities, those in the Western region received more provider time during visits compared with other regions (35 more minutes, p<0.001); and those receiving care at private facilities received more provider time compared with public facilities (13 more minutes, p=0.02); and those at level IV health centres received more time compared with those at level III (12 more minutes, p=0.01). Absent consumables, services for older adults (US$2.28 higher, p=0.02), those with comorbidities (US$1.44 higher, p<0.001) and those living in the Western region (US$2.88 higher, p<0.001) were more expensive compared with younger adults, those without comorbidities and those in other regions, respectively. Inclusive of consumables, services were higher-cost for individuals in wealthier households (US$0.83 higher, p=0.03) and those visiting level IV health centres (US$3.41 higher, p=0.006) compared with level III., Conclusions: Costs and resources for HIV care vary widely throughout Uganda. This variation requires careful consideration: some sources of variation may be indicative of vertical and horizontal equity within the health system, while others may be suggestive of inequities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)