Replication Data for: Costs of HIV prevention services provided by community-based organizations to female sex workers in Nigeria

Background. Nigeria has been consistently targeted in sub-Saharan Africa as an HIV priority country. Its main mode of transmission is heterosexual, and consequently, a key population of interest is female sex workers (FSWs). While HIV prevention services are increasingly implemented by community-based organizations (CBOs) in Nigeria, there is a paucity of evidence on the implementation costs of these organizations. This study seeks to fill this gap by providing new evidence about service delivery unit cost for HIV education (HIVE), HIV counselling and testing (HCT) and sexual transmitted infection (STI) referral services. Methods. In a sample of 31 CBOs across Nigeria, we examined the costs of HIV prevention services for FSWs. We collected 2016 fiscal year data on tablet computers during a central data training in Abuja, Nigeria, in August 2017. Data collection was part of a cluster-randomized trial examining the effects of management practices in CBOs on HIV prevention service delivery. Staff costs, recurrent inputs, utilities and training costs were aggregated and allocated to each intervention to produce total cost calculations, and then divided by the number of FSW served to produce unit costs. Where costs were shared across interventions, a weight proportional to intervention outputs was applied. All cost data were converted to US dollars using the mid-year 2016 exchange rate. We also explored the cost variation across the CBOs, particularly the roles of service scale, geographic location, and time. Results. The average annual number of services provided per CBO were 11,294 for HIVE, 3,326 for HCT, and 473 for STI referrals. The unit cost per FSW tested for HIV was 22 USD, the unit cost per FSW reached with HIV education services was 19 USD, and the unit cost per FSW reached by STI referrals was 3 USD. We found heterogeneity in total and unit costs across CBOs and geographic location. Results from the regression models show that total cost and service scale were positively correlated, while unit costs and scale were consistently negatively correlated; this indicates the presence of economies of scale. By increasing the annual number of services by 100 percent, the unit cost decreases by 50 percent for HIVE, 40 percent for HCT and 10 percent for STI. There was also evidence that indicates that level of service provision was not constant over time across the fiscal year. We also found unit costs and management to be negatively correlated, though results were not statistically significant. Conclusions. Estimates for HCT services are relatively similar to previous studies. There is substantial variation in unit costs across facilities, and evidence of a negative relationship between unit costs and scale for all services. This is one of the few studies to measure HIV prevention service delivery costs to female sex workers through CBOs. Furthermore, this study also looked at the relationship between costs and management practices—the first of its kind to do so in Nigeria. Results can be leveraged to strategically plan for future service delivery across similar settings.

背景：尼日利亚始终是撒哈拉以南非洲地区艾滋病（Human Immunodeficiency Virus, HIV）防控的重点国家。其主要传播途径为异性性行为，因此女性性工作者（female sex workers, FSWs）成为重点关注人群。尽管尼日利亚的社区组织（community-based organizations, CBOs）日益多地开展艾滋病预防服务，但目前鲜有关于这类组织服务实施成本的相关研究证据。本研究旨在填补这一空白，为艾滋病健康教育（HIV education, HIVE）、艾滋病咨询检测（HIV counselling and testing, HCT）以及性传播感染（sexually transmitted infection, STI）转诊服务的服务提供单位成本提供全新研究证据。
方法：本研究选取尼日利亚全国31家社区组织作为样本，针对女性性工作者的艾滋病预防服务成本展开分析。2017年8月，我们在尼日利亚阿布贾举行的中央数据培训期间，收集了2016财年的平板电脑相关数据。本次数据收集隶属于一项整群随机试验（cluster-randomized trial），该试验旨在探究社区组织的管理实践对艾滋病预防服务提供的影响。研究人员将人员成本、经常性投入、公用事业费用及培训成本进行汇总，并分摊至各项干预措施以计算总成本，随后除以服务覆盖的女性性工作者人数得到单位成本。当多项干预措施共享成本时，采用与干预产出成比例的权重进行分摊。所有成本数据均以2016年中期汇率换算为美元。此外，本研究还探究了不同社区组织间的成本差异，重点分析服务规模、地理位置与时间对成本的影响。
结果：每家社区组织年均提供的服务量分别为：艾滋病健康教育服务11294次、艾滋病咨询检测服务3326次、性传播感染转诊服务473次。每接受1次艾滋病检测的女性性工作者对应的单位成本为22美元，每接受1次艾滋病健康教育服务的女性性工作者对应的单位成本为19美元，每获得1次性传播感染转诊服务的女性性工作者对应的单位成本为3美元。研究发现，不同社区组织及不同地理位置的总成本与单位成本均存在异质性。回归模型结果显示，总成本与服务规模呈正相关，而单位成本与服务规模则始终呈负相关，这表明存在规模经济效应。当服务年总量提升100%时，艾滋病健康教育服务的单位成本将下降50%，艾滋病咨询检测服务的单位成本将下降40%，性传播感染转诊服务的单位成本将下降10%。另有证据表明，本财年内的服务提供水平并非始终恒定。此外，研究还发现单位成本与管理水平呈负相关，但该结果未达到统计学显著性水平。
结论：本研究得出的艾滋病咨询检测服务成本估算与既往研究结果较为相近。不同机构的单位成本存在显著差异，且所有服务的单位成本与规模均呈负相关关系。本研究是少数通过社区组织评估女性性工作者艾滋病预防服务提供成本的研究之一。此外，本研究还首次在尼日利亚探究了成本与管理实践之间的关联。本研究结果可用于在类似场景下对未来服务提供进行战略性规划。