Unit costs for the repository are drawn from published literature available through PubMed, POPLINE, HIV InSite, and Google, using the following search criteria: keywords ("HIV", "Cost"), a publication date of 1990 to present, and a developing country focus. Regional-level estimates from the 2009/10 UNAIDS Global Resource Needs Estimates (GRNE) are also included. Please note that studies from upper-income countries, studies that used modeled unit cost estimates that were not based on actual intervention program costs, studies that were repetitive of the same study population/program already included in the repository, studies that gave costs only in charts, studies that did not did not provide a cost per person over a defined period or data from which that unit could be determined, studies that or provided costs only on opportunistic infections, tuberculosis (except as packaged with HIV interventions), or commodities (unless they included the cost for procurement, shipping, insurance and/or social promotion, and studies that did not present any basis for the unit cost given in the study were excluded. A quality review of the prevention articles included in the unit cost repository was undertaken, utilizing a review instrument adapted from: Beck EJ, Harling G, Gerbase S, DeLay P. The cost of treatment and care for people living with HIV infection: implications of published studies, 1999–2008. Current Opinion in HIV and AIDS 2010; 5(3): 215-224. The review instrument will be adapted and utilized for treatment studies to better capture if authors reported indicators that affect treatment costs, such as morbidity levels of the patients and whether services are inpatient or outpatient.
Unit costs are those that are reported by the authors in the studies, and are listed in US dollars, unless only a local currency unit cost was available in the study. In the case where numerous unit costs are given, for example "cost per clinic visit" and "cost per STI syndrome treated", the unit cost closest to the "per-person" (and preferably "per person" completing the program/treatment) level was chosen so as to best standardize the unit of measurement across studies. If a study did not have a unit cost, but did present both a total program cost and the number of persons served, the total program cost was divided by the number of persons served to obtain a unit cost. In addition, for studies that did not clarify if the unit cost was an economic or financial cost, the unit cost was listed in the repository as a financial unit cost.
To facilitate comparison of unit cost details across studies, both the economic and financial unit costs are broken down into five categories: "Personnel unit cost", "Drugs/supplies unit cost", “Laboratory unit cost”, "Other recurrent items (overhead) unit cost", and "Capital goods unit cost". "Personnel unit cost" includes: medical staff, peer educators, and outreach workers. "Drugs/supplies unit cost" includes: drugs (ARVs, OIs, other infections), reproductive health goods (including condoms), medical supplies (needles, gloves, etc.), and "other consumables" (if the text of the article indicates that these items are medical in nature). “Laboratory unit cost” includes: lab fees, test kits, reagents, HIV rapid tests, CD4, VL, chemistry and hematology, tests for OIs, and diagnostic tools such as imaging, "Other recurrent items unit cost" includes: central support/management staff, expatriate consultants, maintenance workers, "supervision", drivers, insurance, utilities/telephone, travel, site visits, publicity and other promotional activities, vehicle maintenance, other electronic maintenance, staff training (recurrent), monitoring, gasoline, meals, and “supplies”. "Capital goods unit cost" includes: start-up, buildings, rent, renovations, vehicles, office furniture, other equipment (autoclaves, typewriters), and staff training (start-up). Please note, if the author had a cost breakdown by category and included a particular cost in a different category from the standard used in the unit cost repository, the category used by the author was maintained in the unit cost repository for that study. For example, if a study included insurance in capital costs, it was kept with capital costs in the unit cost breakdown, with a notation in “Items included” or "Further unit cost detail" that this deviated from the norm set by other studies.
The economic and financial unit costs that are given in the display grid are in 2011 US dollars using the GDP deflator for the appropriate year. Users that click on the “i” button for each study, and then the "Economic unit cost breakdown" or "Financial unit cost breakdown" tabs, will also see the economic and financial unit costs in the original cited US dollar amount (labeled reported currency) and the 2011 US dollar conversion. To convert from the original US dollar amount to 2011 US dollars, the inflation adjustment factor was applied relative to the year the author cited for the unit cost dollar amount. If the author did not give a year for the unit cost in the study, the inflation adjustment factor was applied relative to the year of data gathering given by the author. Finally, if neither the year for the unit cost dollar amount, nor the year of data gathering were given in the study, the year of the study publication was used with the inflation adjustment factor to obtain a 2011 dollar amount.
The Global Resource Needs Estimates validation exercises were conducted for 58 countries across Latin America (12 countries), sub-Saharan Africa (31 countries), and Asia (13 countries). These countries accounted for 83% of the resource needs for all low- and middle-income countries in the 2007 UNAIDS GRNE and 23 of the 25 countries with the largest needs. Each country team consisted of one to four representatives of the national program; several country teams also included UNAIDS M&E Advisors. Prior to the workshops, the participants were provided with country-level models that contained initial default values as well as descriptions of the different interventions that were to be included. During the workshops the participants worked in country teams to enter their data; initial results were presented and discussed by all participants. After the workshops country teams conducted further in-country reviews and submitted final estimates to UNAIDS. Information on the unit costs of services used in the estimates may have come from several sources, including special studies, National AIDS Spending Assessments, budgets or Global Fund applications. All costs were expressed in 2009 US$. Regional results are included here with UNAIDS permission.
Please note that, although it is interpreted as validating the value, when more than half of the countries in a particular region used the initial default unit cost value in their final estimates, this is noted in the "Further unit cost detail" section. Further, although participants were provided with the intervention descriptions, the intervention elements included in their unit costs were not documented, and thus may vary from country to country.
Condom awareness at carnival in Huambo, Angola. "Without a condom, don't do it. Protect yourself." © 2008 Nate Miller, Courtesy of Photoshare; A girl participates in a children's HIV/AIDS fair in rural Concepcion Chiquirichapa, Guatemala. © 2009 Enriqueta Valdez-Curiel, Courtesy of Photoshare; Outreach workers give safe sex tips to sex workers, some of whom are transsexuals, in Kuala Lumpur, Malaysia. Individual farms on small plots of land in Goa, India. © 2006 Dilip Asolkar, Courtesy of Photoshare; Outreach workers give safe sex tips to sex workers, some of whom are transsexuals, in Kuala Lumpur, Malaysia. © 2008 Shabana Palpanaban, Courtesy of Photoshare; FPLM Resident Advisor, Dr. Hafsatou Diallo, estimating needs for 1999 at the Division Laboratorie et Pharmacie, Mali Ministry of Health. © 1999 Yasmin Chandani/FPLM/JSI, Courtesy of Photoshare.