Cost evaluation of PMTCT Programmes

1. Cost evaluation of PMTCT Programmes Gundel Harms1,2, Stefanie Theuring1, Heiko Karcher1, Andrea Kunz1,2, Fred Kagwire3, Paulina Mbezi4, John Odera5 1Institute of Tropical Medicine, Humboldt University Berlin, Germany; 2German Technical Cooperation (GTZ), PMTCT Office Berlin, Berlin, Germany; 3MoH/GTZ PMTCT Programme western Uganda, Fort Portal, Uganda; 4MoH/GTZ PMTCT Programme Mbeya Region, Mbeya, Tanzania; 5MoH/GTZ PMTCT Programme Migori and Kuria Districts, Migori, Kenya  Background GTZ supports nevirapine-based PMTCT Programmes in 2 urban/semi-urban hospitals and 2-3 rural health centres each in Kenya, Tanzania and Uganda. After a preparatory phase, programmes became functional between April and December 2002. Objective We intended to analyse the costs of the PMTCT programmes in the first two years with regard to consequences and effectiveness of the intervention. Figure 1: Costs of PMTCT programmes Methods Costs were categorised as: 1. Costs for programme set up, i.e. costs for local coordination and administration, upgrading of infrastructure, sensitisation of the population, orientation and training of health personnel and procurement of work equipment and supplies - before clients were enrolled. 2. Local programme running costs, i.e. costs for local management, ongoing sensitisation, ongoing orientation and training, procurement of supplies, monitoring and supervision - since clients were enrolled. 3. Costs for expatriate support.  Results Up to December 2003, 24,321 ANC clients were counselled for HIV, 15,392 (63%) decided to be tested, 2,692 (Kenya 19%, Tanzania and Uganda 17%) tested positive, and 1,873 (70%) of those HIV-infected were enrolled into the programme. Costs for programme set up were € 223.165. If only local programme running costs were considered, costs per client counselled were € 16 in Kenya and Tanzania and € 13 in Uganda; per client tested € 23 in Kenya, € 19 in Tanzania and € 22 in Uganda; per client diagnosed HIV positive € 120 in Kenya, € 113 in Tanzania and € 128 in Uganda and per woman enrolled into the programme € 198 in Kenya, € 117 in Tanzania and € 222 in Uganda (Figure 1). In the Uganda programme, transmission rate in 253 children tested at month 6 was 11.9%. Assuming a transmission rate of 30% in this breast feeding population and that all 714 mother-child pairs enrolled in the Uganda programme had taken nevirapine correctly, 130 infections could have been prevented at a cost of € 1,219 each. Assuming that all 1,873 enrolled women in the 3 countries and their newborns had taken nevirapine correctly, 341 infections could have been prevented at a cost of € 958 each. Conclusions PMTCT programmes are expensive. Once established, local running costs for administering PMTCT programmes such as local management, monitoring and supervision, ongoing training, sensitisation and administration should not be underestimated. If cost-effectiveness of PMTCT programmes is to be increased, every effort has to be made to improve the programme uptake.