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Table 2 AVHI services, uptake, and cost of services

From: Service utilization and cost of implementing a comprehensive HIV prevention and care program among people who inject drugs in Delhi, India

 

Total cost (INR)

Number of PWID receiving service

Number of months service provided

Average cost per PWID per year (INR)

Description of program costs

Services under comprehensive package For prevention, treatment, and care Of HIV

 Needle and syringe program (NSP)

3,834,475

2508

26

705.65

Needles and syringes, alcohol swabs, waste disposal, ambulance service including driver and fuel costs (proportionate %), proportionate time for ORWs, and monitoring of the NSP.

 OST referral

86,003

105

22

446.77

Nurses’ time for counseling

 HIV testing and counselinga

4,455,294

7334

32

227.81

All HIV testing using rapid tests at baseline, and 4th generation AgAb tests at FV1 and FV2. HIV testing costs include laboratory cost for testing, phlebotomy costs, personnel costs (nurse) for post-test counseling, and proportionate share of waste disposal costs.

 Referral for ART services and TB testing

2,611,195

1128

36

771.63

Nurse’s proportionate time for counseling and referral, proportionate % of ORW time, and travel costs for following up and escorting PWID.

 STI check-up and treatment

1,395,235

792

36

587.22

Medications given to patients with symptoms and those who tested positive on laboratory test (including unused inventory), doctors’ and nurses’ time (proportionate %), monitoring services, ORW time, and transport costs (proportionate %) to bring back PWID for results and treatment.

 Condom distribution

30,800

2392

26

5.94

Each participant accessing the NSP were offered two condoms at each visit.

 Education and awareness activities

5,471,834

2840

26

889.25

Educational film, educational materials for ORWs, community events, street plays, ORW time, travel costs to visit PWID in the community, and cost for procuring educational films from other sources.

 Hepatitis B testing

1,014,386

2331

12

435.17

Laboratory test Hepatitis B surface Antigen (HBs Ag), proportionate costs for phlebotomy and sample collection, proportionate time of nurses to provide pre- and post-test counseling, and waste disposal.

 Hepatitis B vaccination

1,210,284

1706

26

327.43

Vaccination (vaccine, needle syringe, and alcohol swabs), proportionate time for nurses providing vaccination, proportionate ORW time, and travel costs for locating and reminding PWID to return for their second and third doses, and costs related to monitoring participant follow-up.

 Hepatitis C testing

5,286,627

2330

12

2,268.94

Cost for Hepatitis C IgM/IgG Antibody tests and confirmatory RNA PCR tests. Counseling costs have been included in Hepatitis B counseling.

 Abscess care

2,324,253

1219

36

635.56

Dressing materials, medications (antibiotics, non-steroid anti-inflammatory drugs, and pain killers), ambulance service including driver and fuel costs, proportionate time for medical officer, nurse, and ORW in the ambulance, and waste disposal.

Other Essential Services

 Nutrition

5,756,094

3494

36

549.14

Lunch packets, tea and biscuits, proportionate time for ORWs

 Hygiene

722,688

2941

36

81.91

Bathing kits, proportionate time for ORWs

 Medical consultation

2,994,704

1915

36

521.27

Medications and proportionate time for the doctor and nurse.

 In-patient care and referral for detox/rehab

426,203

267

22

870.69

Cost of service provided by referral NGO per their rates

  1. ORW outreach worker, AgAb antigen-antibody, IgM/IgG immunoglobulin M-immunoglobulin G, RNA ribonucleic acid, PCR polymerase chain reaction
  2. aIndicates number of HIV tests, not number of PWID. PWID underwent HIV testing three times; the national program requires testing every 6 months