P50.07 LB
Background: The CAPRISA 008 implementation trial of 1% tenofovir (TFV) gel randomizes participants to receive TFV gel with family planning (FP) services in a primary health care (PHC) or research clinic setting in South Africa. The CAPRISA 106 ancillary study estimated the cost of using a quality improvement (QI) approach to strengthen FP services and integrate TFV gel provision in the PHC clinic at Vulindlela between June 2012 and January 2014.
Methods: QI activity data were extracted from 86 documents and estimates of eligible client volume, gel uptake and FP visit recall were developed from PHC and CAPRISA service statistics. Unit costs were applied to resources using KwaZulu-Natal Department of Health (DOH) data and other sources. Financial labor costs (additional payment required) were separated from opportunity labor costs (time spent during routine work).
Results: The value of resources required at the district level per PHC clinic for the first year of gel delivery is estimated at 911,946 ZAR ($89,500) and for the QI approach is 190,194 ZAR ($18,660). Recurring annual financial cost for gel delivery is estimated at 895,264 ZAR ($87,850) per clinic. Major financial cost at the district level is for TFV gel procurement with minor labor costs for staff training. The value of resources required at the PHC level per clinic for the first year of gel delivery is 309,587 ZAR ($30,400) and for the QI approach is 126,961 ZAR ($12,460). For gel delivery, recurring annual financial cost is 282,714 ZAR ($22,740) per clinic for additional labor, HIV test kits and other supplies. For the QI approach, recurring annual financial cost is 1,545 ZAR ($152) with opportunity costs estimated at 1.25 nurse days/month and 2.25 data clerk days/month.
Conclusions: The resources required for introducing TFV gel are dominated by cost of the product, as well as additional labor to provide services at PHC clinics. Compared to the costs of TFV gel, introducing a QI approach to support gel delivery imposes minimal cost to the DOH.
