Distribution of Cost and Determinants of Effectiveness in Provision of HIV Testing and Counselling for Male MARPs in Nigeria

Transcription

1 Distribution of Cost and Determinants of Effectiveness in Provision of HIV Testing and Counselling for Male MARPs in Nigeria Designing scale-up interventions targeting male MARPS mindful of M&E could be useful in informing efficient resource allocation to program components that will reduce waste and ensure achievement of desired results, especially in similar resource poor F. N. Ukwuije, G. Eluwa, S. B. Adebajo, A. Oginni, B. Ahonsi, J. Njab, and S. Abdu-Aguye settings. Population Council, Abuja, Nigeria BACKGROUND Nigeria has a generalized epidemic with HIV prevalence rate of 4.1%. Despite recent increases in awareness of HIV, reductions in levels of stigma, and about 400,000 people on anti-retroviral treatment, only 14% of Nigerians know their HIV status, while condom use during higher-risk sex is only 56%. HIV testing and counselling (HTC) remains the gateway to HIV prevention interventions and as countries scale-up towards universal access, priority backed with resource allocation should be given to aspects of HTC programmes that ensure value for money especially in resource poor settings. Men s Health Network Nigeria (MHNN) therefore provided quality HTC; syndromic management of sexually transmitted infections; condom/lubricant to all men with focus on male most-at-risk-population (MARPs). We evaluated the distribution of cost and determinants of effectiveness in the provision of HTC for male MARPs: men who have sex with men (MSM) and men who inject drugs (MWID) in Nigeria. METHODS MSM and MWID were provided with HTC through MHNN, an HIV prevention intervention between July 2009 and July RESULTS Total of USD 295, was spent in providing HTC for 31,609 male MARPs among whom 2,510 tested HIV positive. More than half (54.1%) was spent on personnel; 14% on workshops and meetings, 11.4% on utilities, and 9.2% on M&E (Table 1). Multiple linear regression analysis generated a model that significantly predicted the number of HIV-positive male MARPs reached, F (2, 24) =7.60, p < 0.01 and explained 34% of the variance in the number of HIV-positive male MARPs reached. The model retained the cost (Log 10 ) of promotional materials and the cost (Log 10 ) of M&E but only the cost (log 10 ) of M&E significantly contributed to the prediction (β = 0.49, p = 0.016) (Table 2). Thus, for every unit increase in the cost (Log 10 ) of M&E, there was a significant 2.4 times increase in the number (Log 10 ) of male MARPs who tested HIV positive during the period. TABLE 1 Cost distribution Cost component Cost (USD) % Personnel 159, Meetings 41, Utilities 33, Advocacy 3, Supplies 6, Promotional materials 6, Training 15, M&E 27, Total 295, TABLE 2 Linear regression of number of HIV+ male MARPs reached on cost components of HTC Variable B β p-value Constant Cost of incentives (Log 10 ) Cost of TM&E (Log 10 ) Adjusted R 2 = 0.337, F (2, 24) = 7.601, p = Co-linearity statistics (tolerance) = HIV-positive male MARPs reached (log 10 ) = cost of incentives (Log 10 ) cost of TM&E (Log 10 ) Y = b+ b 1 X 1 +b 2 X 2 Financial costs of providing HTC were estimated from a health provider perspective and classified as capital (rent, furniture, equipment) or recurrent (personnel, stationery, supplies, meetings, monitoring, etc) costs. Effectiveness was measured as the number of clients who tested positive to HIV. Exploratory analyses were conducted to test for the assumption of normal distribution. Variables with skewed distribution were logarithmized to the base of 10. Multiple linear regression analysis was conducted to determine the best linear combination of cost components for reaching HIV positive male MARPs. The dependent variable was the number of male MARPs that tested HIV positive during the period, while the independent variables were the following cost components: (1) Personnel ; (2) Workshops and Meetings; (3) Utilities ; (4) Advocacy; (5) Supplies; (6) Promotional materials (incentives); (7) Training ; and Monitoring & Evaluation [M&E]. CONCLUSION Although personnel cost is over half of the total average cost of the program, it was not significant in increasing the number of male MARPS who tested HIV positive contrary to M&E which as a component is rather small. Our study therefore shows that marginal increase in spending on M&E can significantly contribute to program effectiveness especially among male MARPS, who in our context are a hidden population. Designing scale-up interventions targeting male MARPS with this in mind could be useful in informing efficient resource allocation to program components that will reduce waste and ensure achievement of desired results, especially in similar resource poor settings. Further research is required to determine how M&E directly affects program effectiveness. FUNDING AND CONTACT INFORMATION Funding for MHNN was provided by President s Emergency Plan for AIDS Relief (PEPFAR) through a cooperative agreement with the Centers for Disease Control and Prevention (CDC). The poster contents are the sole responsibility of the authors and do not necessarily reflect the views of CDC or the United States Government. For more information, please contact Francis Ukwuije at fukwuije@popcouncil.org.

2 POSTER PRESENTATION 17th INTERNATIONAL CONFERENCE ON AIDS AND 7 11 DEC 2013 SEXUALLY TRANSMITTED INFECTIONS IN AFRICA CAPE TOWN, SOUTH AFRICA Distribution of Cost and Determinants of Effectiveness in Provision of HIV Testing and Counselling for Male MARPs in Nigeria F. N. Ukwuije, G. Eluwa, S. B. Adebajo, A. Oginni, B. Ahonsi, J. Njab, and S. Abdu-Aguye Population Council, Nigeria Designing scale-up interventions targeting male MARPS mindful of M&E could be useful in informing efficient resource allocation to program components that will reduce waste and ensure achievement of desired results, especially in similar resource poor settings. BACKGROUND Nigeria has a generalized epidemic with HIV prevalence rate of 4.1%. Despite recent increases in awareness of HIV, reductions in levels of stigma, and about 400,000 people on anti-retroviral treatment, only 14% of Nigerians know their HIV status, while condom use during higher-risk sex is only 56%. HIV testing and counselling (HTC) remains the gateway to HIV prevention interventions and as countries scale-up towards universal access, priority backed with resource allocation should be given to aspects of HTC programmes that ensure value for money especially in resource poor settings. Men s Health Network Nigeria (MHNN) therefore provided quality HTC; syndromic management of sexually transmitted infections; condom/lubricant to all men with focus on male most-at-riskpopulation (MARPs). We evaluated the distribution of cost and determinants of effectiveness in the provision of HTC for male MARPs: men who have sex with men (MSM) and men who inject drugs (MWID) in Nigeria.

3 METHODS MSM and MWID were provided with HTC through MHNN, an HIV prevention intervention between July 2009 and July Financial costs of providing HTC were estimated from a health provider perspective and classified as capital (rent, furniture, equipment) or recurrent (personnel, stationery, supplies, meetings, monitoring, etc) costs. Effectiveness was measured as the number of clients who tested positive to HIV. Exploratory analyses were conducted to test for the assumption of normal distribution. Variables with skewed distribution were logarithmized to the base of 10. Multiple linear regression analysis was conducted to determine the best linear combination of cost components for reaching HIV positive male MARPs. The dependent variable was the number of male MARPs that tested HIV positive during the period, while the independent variables were the following cost components: (1) Personnel ; (2) Workshops and Meetings; (3) Utilities ; (4) Advocacy; (5) Supplies; (6) Promotional materials (incentives); (7) Training ; and Monitoring & Evaluation [M&E]. RESULTS Total of USD 295, was spent in providing HTC for 31,609 male MARPs among whom 2,510 tested HIV positive. More than half (54.1%) was spent on personnel; 14% on workshops and meetings, 11.4% on utilities, and 9.2% on M&E (Table 1). TABLE 1 Cost distribution Cost component Cost (USD) % Personnel 159, Meetings 41, Utilities 33, Advocacy 3, Supplies 6, Promotional materials 6, Training 15, M&E 27, Total 295,

4 Multiple linear regression analysis generated a model that significantly predicted the number of HIV-positive male MARPs reached, F (2, 24) =7.60, p < 0.01 and explained 34% of the variance in the number of HIV-positive male MARPs reached. The model retained the cost (Log10) of promotional materials and the cost (Log10) of M&E but only the cost (log10) of M&E significantly contributed to the prediction (β = 0.49, p = 0.016) (Table 2). Thus, for every unit increase in the cost (Log10) of M&E, there was a significant 2.4 times increase in the number (Log10) of male MARPs who tested HIV positive during the period. TABLE 2 Linear regression of number of HIV-positive male MARPs reached on cost components of HTC Variable B β p-value C Cost of incentives (Log10) Cost of TM&E (Log10) CONCLUSION Although personnel cost is over half of the total average cost of the program, it was not significant in increasing the number of male MARPS who tested HIV positive contrary to M&E which as a component is rather small. Our study therefore shows that marginal increase in spending on M&E can significantly contribute to program effectiveness especially among male MARPS, who in our context are a hidden population. Designing scale-up interventions targeting male MARPS with this in mind could be useful in informing efficient resource allocation to program components that will reduce waste and ensure achievement of desired results, especially in similar resource poor settings. Further research is required to determine how M&E directly affects program effectiveness. 3

5 ACKNOWLEDGMENTS Funding for MHNN was provided by President s Emergency Plan for AIDS Relief (PEPFAR) through a cooperative agreement with the Centers for Disease Control and Prevention (CDC). The poster contents are the sole responsibility of the authors and do not necessarily reflect the views of CDC or the United States Government. For more information, please contact Francis Ukwuije at fukwuije@popcouncil.org. The Population Council confronts critical health and development issues from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world. Established in 1952 and headquartered in New York, the Council is a nongovernmental, nonprofit organization governed by an international board of trustees.