National Evaluation of HIV Service Resource Allocation in Tanzania

AIDS Behav. 2023 Oct;27(10):3498-3507. doi: 10.1007/s10461-023-04065-5. Epub 2023 May 5.

Abstract

Using time-driven activity-based costing (TDABC), we examined resource allocation and costs for HIV services throughout Tanzania at patient and facility levels. This national, cross-sectional analysis of 22 health facilities quantified costs and resources associated with 886 patients receiving care for five HIV services: antiretroviral therapy, prevention of mother-to-child transmission, HIV testing and counseling, voluntary medical male circumcision, and pre-exposure prophylaxis. We also documented total provider-patient interaction time, the cost of services with and without inclusion of consumables, and conducted fixed-effects multivariable regression analyses to examine patient- and facility-level correlates of costs and provider-patient time. Findings showed that resources and costs for HIV care varied significantly throughout Tanzania, including as a function of patient- and facility-level characteristics. While some variation may be preferable (e.g., needier patients received more resources), other areas suggested a lack of equity (e.g., wealthier patients received more provider time) and presented opportunities to optimize care delivery protocols.

Keywords: Cost analysis; Equity; Health systems strengthening; Resource allocation; Time-driven activity-based costing.

MeSH terms

  • Cross-Sectional Studies
  • Female
  • HIV Infections* / drug therapy
  • HIV Infections* / epidemiology
  • HIV Infections* / prevention & control
  • Humans
  • Infectious Disease Transmission, Vertical / prevention & control
  • Male
  • Resource Allocation
  • Tanzania / epidemiology