Expenditure Analysis of HIV Testing and Counseling Services Using the Cascade Framework in Vietnam.
Expenditure Analysis of HIV Testing and Counseling Services Using the Cascade Framework in Vietnam.
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DOI：
10.1371/journal.pone.0126659
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
West G
中科院分区：
文献类型：
--
作者：
Nguyen VT;Nguyen HT;Nguyen QC;Duong PT;West G
目前，越南的艾滋病毒检测和咨询（HTC）服务主要由国际来源资助。然而，国际资助者现在正计划撤回他们的支持，越南政府正在寻求确定国内资金并产生客户费用以继续提供服务。清晰地了解维持目前HTC服务的成本对于促进规划变得越来越重要，从而使HTC和其他艾滋病毒服务在越南更加负担得起和可持续。本分析的目的是提供当前项目成本的快照，以实现关键项目成果，包括1)检测和识别不知道其艾滋病毒状况的PLHIV和2)成功地将艾滋病毒（+）客户纳入护理。我们审查了2012年10月至2013年9月期间越南9个省34个HTC站点报告的支出数据。项目结果的数据是从HTC数据库的42390个客户记录中提取的。从服务提供者的角度进行分析。提供HTC服务（检测、接收结果和转介护理/治疗）的单个客户的平均支出为7.6美元。通过这些服务确定的每名艾滋病毒感染者的单位支出从22.8美元到741.5美元不等（中位数：131.8美元）。排除重复检测，用于新诊断艾滋病毒的支出范围更大（从30.8美元到1483.0美元）。一名成功转介艾滋病毒客户到护理服务的平均支出为466.6美元。人事成本占总成本的比重最大。我们的分析发现，为了达到同样的结果，不同地点的支出范围很广。重新设计系统，以尽可能低的成本提供服务，对于使越南的艾滋病毒服务更容易负担和预防治疗方案可行至关重要。分析还发现，了解不同地点服务成本差异的决定因素和原因，是对艾滋病毒服务级联框架的重要改进，该框架现已适应并在越南广泛用于规划和评估。
Currently, HIV testing and counseling (HTC) services in Vietnam are primarily funded by international sources. However, international funders are now planning to withdraw their support and the Government of Vietnam (GVN) is seeking to identify domestic funding and generate client fees to continue services. A clear understanding of the cost to sustain current HTC services is becoming increasingly important to facilitate planning that can lead to making HTC and other HIV services more affordable and sustainable in Vietnam. The objectives of this analysis were to provide a snapshot of current program costs to achieve key program outcomes including 1) testing and identifying PLHIV unaware of their HIV status and 2) successfully enrolling HIV (+) clients in care. We reviewed expenditure data reported by 34 HTC sites in nine Vietnamese provinces over a one-year period from October 2012 to September 2013. Data on program outcomes were extracted from the HTC database of 42,390 client records. Analysis was carried out from the service providers’ perspective. The mean expenditure for a single client provided HTC services (testing, receiving results and referral for care/treatment) was US $7.6. The unit expenditure per PLHIV identified through these services varied widely from US $22.8 to $741.5 (median: $131.8). Excluding repeat tests, the range for expenditure to newly diagnose a PLHIV was even wider (from US $30.8 to $1483.0). The mean expenditure for one successfully referred HIV client to care services was US $466.6. Personnel costs contributed most to the total cost. Our analysis found a wide range of expenditures by site for achieving the same outcomes. Re-designing systems to provide services at the lowest feasible cost is essential to making HIV services more affordable and treatment for prevention programs feasible in Vietnam. The analysis also found that understanding the determinants and reasons for variance in service costs by site is an important enhancement to the cascade of HIV services framework now adapted for and extensively used in Vietnam for planning and evaluation.
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