Washington D.C., USA, 22-27 July 2012www.aids2012.org

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

Abstract no. FRAE0103

Washington D.C., USA, 22-27 July 2012www.aids2012.org

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

Washington D.C., USA, 22-27 July 2012www.aids2012.org

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

Washington D.C., USA, 22-27 July 2012www.aids2012.org

• 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?

Study questions

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Methodology• Used mixed methods

o Document reviewo Key informant interviews

• Analyzed the cost of main facility-based PMTCT services under new PMTCT guidelines o HIV testing and counseling (HTC)o 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 o Based on national guidelineso 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

Washington D.C., USA, 22-27 July 2012www.aids2012.org

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

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Key Results

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Unit cost for Mother/Child pairs (USD)

Mother: Sero-negative

Mother: ARV Prophylaxis / HIV-exposed infant (6 wks)

Mother: ARV Prophylaxis / HIV-exposed infant (6 mo.)

Mother: ARV Prophylaxis / HIV-exposed

infant (12 mo.)

Mother: ARV Treatment / HIV-exposed infant (6 wks)

Mother: ARV Treatment / HIV-exposed infant (6 mo.)

Mother: ARV Treatment / HIV-exposed

infant (12 mo.)

$-

$200

$400

$600

$800

$1,000

$1,200

$56

$739 $739 $739

$1,054 $1,054 $1,054

$29 $50 $69

$29 $50 $69 Mother Cost Infant Cost

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Distribution of Costfor Mother-Child Pairs

Mother: ARV Prophylaxis / HIV-exposed

infant (6 wks)

Mother: ARV Prophylaxis / HIV-exposed

infant (6 mo.)

Mother: ARV Prophylaxis / HIV-exposed

infant (12 mo.)

Mother: ARV Treatment /

HIV-exposed infant (6

wks)

Mother: ARV Treatment /

HIV-exposed infant (6

mo.)

Mother: ARV Treatment /

HIV-exposed infant (12

mo.)

96% 94% 91% 97% 95% 94%

4% 6% 9% 3% 5% 6%

Mother Cost Infant Cost

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Distribution of Direct and Indirect Costs, by Mother/Child

Pairs

Mother: Sero-negative

Mother: ARV Prophylaxis / HIV-exposed infant (6 wks)

Mother: ARV Prophylaxis / HIV-exposed infant (6 mo.)

Mother: ARV Prophylaxis / HIV-exposed

infant (12 mo.)

Mother: ARV Treatment / HIV-exposed infant (6 wks)

Mother: ARV Treatment / HIV-exposed infant (6 mo.)

Mother: ARV Treatment / HIV-exposed

infant (12 mo.)

100.000%

75.831% 76.467% 77.005% 82.856% 83.179% 83.456%

13.710% 13.350% 13.044%9.725% 9.542% 9.385%

10.459% 10.184% 9.951% 7.419% 7.279% 7.159%

Direct Cost Indirect Facility Costs General Program Supprt

Washington D.C., USA, 22-27 July 2012www.aids2012.org

• 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

PMTCT Costs are Driven by Direct Costs

Washington D.C., USA, 22-27 July 2012www.aids2012.org

• 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.

Task Shifting

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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.

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Thank You!

aeladas@ghanaids.gov.gh