University of Washington



You are conducting a micro-costing of a home-based HIV testing intervention in Kenya. You plan to obtain costs from an ongoing randomized control trial of home-based HIV testing. The costs and effectiveness of the trial will be used in a cost-effectiveness analysis to determine if scaling up the intervention would be a good use of resources for the Kenyan government.The intervention staff consists of 1 project manager, 12 lay counselors that administer the intervention, 4 community mobilizers, and 1 office manager that is shared (50%) with another HIV intervention. After talking to stakeholders, you estimate that if the intervention were administered as a government program, the number of lay counselors would increase to 20 and the number of community mobilizers would increase to 6. The rest of the staff structure would remain the same. You look up government salaries for each position and come up with the following numbers:Position Title Net Salary (per person) KSHFringe benefitsProject manager1,500,00084,000Lay counselor900,00084,000Community mobilizer360,00084,000Office manager800,00084,000The intervention uses 2 vehicles to transport lay counselors to the sites where they conduct the home HIV testing. After some research, you estimate that 4 vehicles would be needed if the intervention were implemented as a government program. Vehicles are assumed to have 5 years of useful life.ItemPurchase DateUnit Cost KSHSUV Landrover28/02/141,300,500Below are the recurrent costs associated with the vehicles:VehicleWeekly distance traveledWeeks worked per yearFuel consumption(km/lit)Fuel price($/lit) KSHregistration, inspectionMaintenance cost(KSH/year)SUV Landrover15044101202005500Next you take stock of the intervention equipment. You come up with the list below. Note: The cost of the PC is in US dollars, not KSH. Office furniture is assumed to have 10 years of useful life while all other equipment is assumed to have 5 years useful life.ItemUnit CostNumberCabinet$18,695.003Office desk$9,699.003Office chairs$2,815.1526PC$700.002Laptop computer with printer$58,000.001Mobile phones$500.0020Staff back packs$6,500.0026Conference table$24,000.001Supplies needed for the intervention include HIV testing materials per client tested, as well as general supplies. Kenya uses an HIV testing algorithm of 1) screening test 2) confirmatory test if screening test is positive, and 3) tie breaker test if screen is positive and confirmatory test is negative. The population reached by the HIV testing intervention has a 20% HIV prevalence so you assume the fraction of confirmatory tests used per visit is 0.20. The tie breaker is used in approximately 5% of cases. You assume 5% of the hand sanitizer bottle is used per visit. You also assume a 5% wastage of all supplies.Supplies per visit (all costs in KSH)ItemNumberTotal CostDual Safe powdered gloves100$464.00HIV rapid screening test576$71,037.00Capillary tubes100$348.00Hand sanitizer (2 oz)1$100.0070% Alcohol swabs100$290.00First response (confirmatory test)480$77,614.50Unigold (tie breaker test)10$2,200.40 General suppliesItemYearly costCurrency (1=US, 2=local)Pens$3,000.002Notebooks$2,000.002Printing paper$45,000.002Toner$6,400.002Printer cartridges$9,000.002The home testing intervention is housed in a hospital space that is shared (50% with another intervention). The hospital donates the space to use in the intervention. You look up the monthly cost of renting a similar space in the Kisumu, Kenya area. It is listed below. All costs are in KSH except the internet cost, which is in US dollars. All costs are split with the other intervention sharing the space.ItemTotal monthly costmonths usedOffice space in clinic54,00012Water35012internet11612Electricity2,35012You conduct time and motion studies and interviews with staff, supervisors, and stakeholders. Based on this, you estimate that each lay counselor can test 5 participants per day. Counselors work 5 days a week and are given 20 vacation days, 13 public holidays, 5 sick days, and 5 days for Christmas break. Fill in the table on the summary tab with this information.Based on this information, what is the estimated yearly cost of the intervention run as a government program? What is the cost per person tested?Bonus questions: How would you incorporate startup costs (staff hiring and training) into the microcosting?What other costs are missing? You want to compare the costs of this HIV testing intervention with standard clinic HIV testing. You find cost estimates from the literature for clinic HIV testing in Kenya: $9.50 USD (2013 dollars). What is the cost of clinic HIV testing in US 2014 dollars?YearGDP deflator2015153.72014140.82013130.4……2010102.12009100YearExchange rate201487.7201386.12Formula:Current cost ($) = (base year cost) * (Current GDP deflator) / (Base year GDP deflator) ................
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