Dr. Angela El-Adas Director-General, Ghana AIDS Commission

1. Abstract no. FRAE0103 Economic Evaluation of the National Program to Prevent Mother-to-Child Transmission of HIV in Ghana Dr. Angela El-Adas Director-General, Ghana AIDS Commission

2. Study Team • Ghana AIDS Commission • A. El-Adas • R. Amenyah • K. Atuahene • Futures Group, Health Policy Project • A. Koleros • Ghana Health Service, National AIDS and STI Control Program • N. Akwei Addo • K. Asante • University of Ghana, Institute of Statistical, Social, and Economic Research • F. Asante • USAID Ghana • P. Wondergem

3. Background • Government of Ghana introduced new National PMTCT Guidelines in 2010 • New World Health Organization (WHO) clinical guidelines • New antiretroviral (ARV) drug regimens • Clinical services as part of routine care for PMTCT clients • No studies in Ghana had examined the cost of delivering these services • Few international studies have examined costs of PMTCT services under new WHO guidelines

4. Study questions • What is the cost of providing PMTCT services for one woman and child from pregnancy through the recommended period of postpartum care according to national guidelines? • Cost of providing PMTCT services to an HIV-negative woman? • Cost of providing PMTCT services to an HIV-positive woman? • Cost of providing PMTCT services to an HIV-exposed infant?

5. Methodology • Used mixed methods • Document review • Key informant interviews • Analyzed the cost of main facility-based PMTCT services under new PMTCT guidelines • HIV testing and counseling (HTC) • Antiretroviral prophylaxis and/or therapy for sero-positive pregnant women and postpartum care for sero-positive mothers and their HIV-exposed infants • Developed a representative care schedule • Based on national guidelines • Refined during interviews • Collected data at the central level and from a purposive sample of 14 facilities reflecting characteristics thought to influence unit cost, including facility level and facility ownership

6. Definition of PMTCT • The cost of providing PMTCT services to one woman from intake in the PMTCT program during the 1st trimester through the recommended period of postpartum care • The cost of providing PMTCT services to one HIV-exposed infant from delivery through the recommended period of postpartum care • Total period of 21 months • 9 months of pregnancy • 12 months of breastfeeding

7. Key Results

8. Unit cost for Mother/Child pairs (USD)

9. Distribution of Costfor Mother-Child Pairs

10. Distribution of Direct and Indirect Costs, by Mother/Child Pairs

11. PMTCT Costs are Driven by Direct Costs • ARVs and associated lab tests constituted the largest cost components of both direct costs and overall costs. • The data suggest that the unit cost of delivering PMTCT services will not vary significantly over time unless cost of ARVs are driven down

12. Task Shifting • Staff time was also a relatively large contributor to overall costs. • Higher staff costs were associated with higher-level facilities. • Further task shifting within PMTCT could achieve some cost savings in the long term. • Requires investments in training and building capacity to ensure that the quality of service delivery is maintained.

13. Conclusions • The study provided insight into • What is driving PMTCT costs • What can be done to achieve cost efficiencies • These data can be used to better inform resource allocation decisions as PMTCT programs are scaled up across Ghana and other countries.

14. Thank You! aeladas@ghanaids.gov.gh