Cost, cost-efficiency and cost-effectiveness of integrated family planning and HIV services

OBJECTIVE:To evaluate costs, cost-efficiency and cost-effectiveness of integration of family planning into HIV services. INTERVENTION:Integration of family planning services into HIV care and treatment clinics. DESIGN:A cluster-randomized trial. SETTING:Twelve health facilities in Nyanza, Kenya were randomized to integrate family planning into HIV care and treatment; six health facilities were randomized to (nonintegrated) standard-of-care with separately delivered family planning and HIV services. MAIN OUTCOME MEASURES:We assessed costs, cost-efficiency (cost per additional use of more effective family planning), and cost-effectiveness (cost per pregnancy averted) associated with the first year of integration of family planning into HIV care. More effective family planning methods included oral and injectable contraceptives, subdermal implants, intrauterine device, and female and male sterilization. PATIENTS AND PARTICIPANTS:We collected cost data through interviews with study staff and review of financial records to determine costs of service integration. RESULTS:Integration of services was associated with an average marginal cost of $841 per site and $48 per female patient. Average overall and marginal costs of integration were associated with personnel costs [initial ($1003 vs. $872) and refresher ($498 vs. $330) training, mentoring ($1175 vs. $902) and supervision ($1694 vs. $1636)], with fewer resources required for other fixed ($18 vs. $0) and recurring expenses ($471 vs. $287). Integration was associated with a marginal cost of $65 for each additional use of more effective family planning and $1368 for each pregnancy averted. CONCLUSION:Integration of family planning and HIV services is feasible, inexpensive to implement, and cost-efficient in the Kenyan setting, and thus supports current Kenyan integration policy.