1. Washington D.C., USA, 22-27 July 2012www.aids2012.org Economic Evaluation of the National Program to Prevent Mother-to-Child Transmission of HIV in Ghana Dr. Angela El-Adas Director-General, Ghana AIDS Commission Abstract no. FRAE0103

2. Washington D.C., USA, 22-27 July 2012www.aids2012.org Study Team Ghana AIDS Commission –A. El-Adas –R. Amenyah –K. Atuahene Futures Group, Health Policy Project –A. Koleros Ghana Health Service, National AIDS and STI Control Program –N. Akwei Addo –K. Asante University of Ghana, Institute of Statistical, Social, and Economic Research –F. Asante USAID Ghana –P. Wondergem

3. Washington D.C., USA, 22-27 July 2012www.aids2012.org Background Government of Ghana introduced new National PMTCT Guidelines in 2010 –New World Health Organization (WHO) clinical guidelines –New antiretroviral (ARV) drug regimens –Clinical services as part of routine care for PMTCT clients No studies in Ghana had examined the cost of delivering these services Few international studies have examined costs of PMTCT services under new WHO guidelines

4. Washington D.C., USA, 22-27 July 2012www.aids2012.org What is the cost of providing PMTCT services for one woman and child from pregnancy through the recommended period of postpartum care according to national guidelines? –Cost of providing PMTCT services to an HIV-negative woman? –Cost of providing PMTCT services to an HIV-positive woman? –Cost of providing PMTCT services to an HIV-exposed infant? Study questions

5. Washington D.C., USA, 22-27 July 2012www.aids2012.org Methodology Used mixed methods o Document review o Key informant interviews Analyzed the cost of main facility-based PMTCT services under new PMTCT guidelines o HIV testing and counseling (HTC) o Antiretroviral prophylaxis and/or therapy for sero-positive pregnant women and postpartum care for sero-positive mothers and their HIV-exposed infants Developed a representative care schedule o Based on national guidelines o Refined during interviews Collected data at the central level and from a purposive sample of 14 facilities reflecting characteristics thought to influence unit cost, including facility level and facility ownership

6. Washington D.C., USA, 22-27 July 2012www.aids2012.org Definition of PMTCT The cost of providing PMTCT services to one woman from intake in the PMTCT program during the 1 st trimester through the recommended period of postpartum care The cost of providing PMTCT services to one HIV- exposed infant from delivery through the recommended period of postpartum care Total period of 21 months – 9 months of pregnancy – 12 months of breastfeedin g

7. Washington D.C., USA, 22-27 July 2012www.aids2012.org Key Results

8. Washington D.C., USA, 22-27 July 2012www.aids2012.org Unit cost for Mother/Child pairs (USD)

9. Washington D.C., USA, 22-27 July 2012www.aids2012.org Distribution of Cost for Mother-Child Pairs

10. Washington D.C., USA, 22-27 July 2012www.aids2012.org Distribution of Direct and Indirect Costs, by Mother/Child Pairs

11. Washington D.C., USA, 22-27 July 2012www.aids2012.org ARVs and associated lab tests constituted the largest cost components of both direct costs and overall costs. The data suggest that the unit cost of delivering PMTCT services will not vary significantly over time unless cost of ARVs are driven down PMTCT Costs are Driven by Direct Costs

12. Washington D.C., USA, 22-27 July 2012www.aids2012.org Staff time was also a relatively large contributor to overall costs. Higher staff costs were associated with higher-level facilities. Further task shifting within PMTCT could achieve some cost savings in the long term. –Requires investments in training and building capacity to ensure that the quality of service delivery is maintained. Task Shifting

13. Washington D.C., USA, 22-27 July 2012www.aids2012.org Conclusions The study provided insight into –What is driving PMTCT costs –What can be done to achieve cost efficiencies These data can be used to better inform resource allocation decisions as PMTCT programs are scaled up across Ghana and other countries.

14. Washington D.C., USA, 22-27 July 2012www.aids2012.org Thank You! aeladas@ghanaids.gov.gh