An expenditure analysis provides critical information to help lower costs and sustain HIV services in Vietnam
The decline in international funding for HIV services has shifted a substantial financial burden to the Vietnamese government. HIV testing and counseling centers (HTCs) are being hit particularly hard due to a funding gap. There is an urgent need to close this gap: HTCs are essential to controlling the HIV epidemic in Vietnam.
HTCs serve as the entry point to the continuum of HIV prevention to care. They identify many of the approximately 14,000 new HIV cases reported each year in the country and play an important role in referring HIV-positive individuals to centers providing antiretroviral treatment. About 80,000 of the country’s approximately 250,000 HIV-positive individuals are receiving antiretroviral treatment.
To sustain HTCs, it is necessary to establish new funding sources and identify ways to reduce costs. But, how? To answer this question, FHI 360 performed an expenditure analysis, the results of which are explored in depth in our recent publication. Below is a brief summary of our findings.
The expenditure analysis estimated the costs required to achieve the program’s two key outcomes:
- Testing and identifying persons living with HIV (PLHIV) who are unaware of their HIV status
- Successfully enrolling HIV-positive clients in care and treatment
Study data covered expenditures from October 2012 to September 2013 encompassing 34 HTCs in nine provinces that receive funding from the U.S. Agency for International Development-funded Sustainable Management of the HIV/AIDS Response and Transition to Technical Assistance project.
Across all 34 sites, the average expenditure for a single client receiving basic HTC services (testing, obtaining results, and referral for care and treatment) was US$7.60. The unit expenditure per PLHIV identified through these services varied greatly, from US$22.80 to $741.50, with a median cost of US$131.80. Excluding repeat tests, the range for expenditure to newly diagnose a client was even wider — US$30.80 to $1,483.00. The average expenditure for one HIV client successfully referred to care services was US$466.60.
The wide range of expenditures across sites achieving the same outcomes is a crucial finding. Redesigning systems to provide services at the lowest feasible cost is essential. The analysis identified the main determinants of high costs as too many personnel at the site level and low productivity.
These findings suggest that sites should review their staffing needs and referral systems to ensure reasonable workloads and effective, efficient systems. Reducing staff costs and improving service performance will be vital to achieving a sustainable service model and affordable costs. The findings from this analysis can serve as a basis for policymakers and planners to plan, budget and mobilize resources required to sustain the services needed to combat the Vietnamese HIV epidemic.
Photo credit: FHI 360/Vietnam