Costs of scaling-up programme for men who have sex with men (MSM) in Bangalore over three years, Karnataka, India
S. Chandrashekar1,2, L. Guinness2, A. Vassal2, B. Reddy3, G. Shetty3, J. Anthony4, R. Watts5, M. Alary6
1St.John’s Research Institute, Epidemiology, Bangalore, India, 2London School of Hygiene & Tropical Medicine, Public Health and Policy, London, United Kingdom, 3Karnataka Health Promotion Trust, CHARME Project, Bangalore, India, 4Karnataka Health Promotion Trust, Bangalore, India, 5Sangama, Bangalore, India, 6Centre Hospital Affiliare, Quebec, Canada
Background: Avahan, The India AIDS Initiative of the Bill & Melinda Gates Foundation is involved in rapid scale up of HIV prevention targeted at high risk populations in India. MSM account for 5-10% of HIV transmission globally (UNAIDS) yet HIV prevention efforts targeted at MSM constitute a very small proportion of overall prevention expenditure, and there is scarce evidence on their costs. A study of MSM in Bangalore (2008), capital city of Karnataka district showed a HIV prevalence of 18.9%. This study presents costs of scaling up the MSM component of Avahan over three years to reach target population of above 6000 in Bangalore.
Methods: Financial and economic costs were prospectively collected. Costs are presented in US$ 2008 and 3% discount rate. Start-up costs, costs by activity, costs of interventions over the three years as they scaled up (2005-2008) were analyzed
Results: The economic cost of the programme over three years was US$ 920,101. The cost per person registered decreased from $88 in the first year to $64 in the third year while the scale increased from 1368 to 6984 registered persons (saturation).Costs per member availing STI services, fell from $ 252 to $ 96 for the MSM programme while costs for STI services of a programme for Female sex workers in the same district fell from $ 188 to $ 71. Costs broken down by activity were condom promotion (20.7%). STI services (19.7%), behavior change communication (11.8%), community mobilization (11.8%), capacity building(10.9%), Planning(8.9%), Programme monitoring (6.5), advocacy and enabling environment (6%).and start-up (3.5%).
Conclusions: As costs vary considerably by scale, it is important to measure costs when service utilization increases to provide policy makers and planners with accurate estimates of long-run programme costs and also variation in the costs compared to Female sex worker programmes.