The cost of community outreach HIV interventions: a case study in Thailand

Kyaw Min Soe; Katharina Hauck; Sukhum Jiamton; Sukhontha Kongsin

doi:10.1186/s12889-021-12416-x

The cost of community outreach HIV interventions: a case study in Thailand

BMC Public Health. 2022 Jan 6;22(1):20. doi: 10.1186/s12889-021-12416-x.

Authors

Kyaw Min Soe^{1

2}, Katharina Hauck², Sukhum Jiamton^{1

3}, Sukhontha Kongsin⁴

Affiliations

¹ Research Centre for Health Economics and Evaluation, Faculty of Public Health, Mahidol University, 420/1 Ratchawithi Rd, Khet Ratchathewi, Bangkok, 10400, Thailand.
² Department of Infectious Disease Epidemiology, Faculty of Medicine, School of Public Health, Imperial College London, London, UK.
³ Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
⁴ Research Centre for Health Economics and Evaluation, Faculty of Public Health, Mahidol University, 420/1 Ratchawithi Rd, Khet Ratchathewi, Bangkok, 10400, Thailand. sukhontha.kon@mahidol.edu.

Abstract

Background: There was an estimated 440,000 people living with HIV in Thailand in 2018. New cases are declining rapidly thanks to successful prevention programs and scaling up of anti-retroviral therapy (ART). Thailand aims to achieve its commitment to end the HIV epidemic by 2030 and implemented a cascade of HIV interventions through the Reach-Recruit-Test-Treat-Retain (RRTTR) program.

Methods: This study focused on community outreach HIV interventions implemented by Non-Governmental Organizations (NGOs) under the RRTTR program in 27 provinces. We calculated unit cost per person reached for HIV interventions targeted at key-affected populations (KAPs) including men who have sex with men/ transgender (MSM/TG), male sex workers (MSW), female sex workers (FSW), people who inject drugs (PWID) and migrants (MW). We studied program key outputs, costs, and unit costs in variations across different HIV interventions and geographic locations in Thailand. We used these estimates to determine costs of HIV interventions and evaluate economies of scale.

Results: The interventions for migrants in Samut Sakhon was the least costly with a unit cost of 21.6 USD per person to receive services, followed by interventions for migrants in Samut Prakan 23.2 USD per person reached, MSM/TG in Pratum Thani 26.5USD per person reached, MSM/TG in Nonthaburi 26.6 USD per person reached and, MSM/TG in Chon Buri with 26.7 USD per person. The interventions yielded higher efficiency in large metropolitan and surrounding provinces. Harm reduction programs were the costliest compare with other interventions. There was association between unit cost and scale of among interventions indicating the presence of economies scale. Implementing HIV and TB interventions jointly increased efficiency for both cases.

Conclusion: This study suggested that unit cost of community outreach HIV and TB interventions led by CSOs will decrease as they are scaled up. Further studies are suggested to follow up with these ongoing interventions for identifying potential contextual factors to improve efficiency of HIV prevention services in Thailand.

Keywords: Community-based; Cost; HIV intervention; Thailand; Unit cost.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Community-Institutional Relations
Female
HIV Infections* / drug therapy
HIV Infections* / prevention & control
Homosexuality, Male
Humans
Male
Sex Workers*
Sexual and Gender Minorities*
Thailand / epidemiology

Grants and funding

MR/R015600/1/MRC_/Medical Research Council/United Kingdom