Sub-district costs and efficiency of a combination HIV/AIDS prevention-intervention in the Northwest Province of South Africa




Costs efficiency, combination, prevention, HIV/ AIDS, South Africa


Background: We reviewed a combination prevention program tostrengthen HIV prevention programming, community support mechanisms, community-based HIV testing, referral systems, and HIV prevention integration at the primary care level. The intervention included situational analysis to inform programming, community engagement and mobilization, and community-based biomedical and behavioral prevention. In support of PEPFAR’s country-ownership paradigm, we costed the combination HIV prevention program to determine data needed for local ownership. This research used costing and health system perspectives.
Results: Cost per person reached with individual or small group prevention interventions ranged from $63.93 to $4,344.88. (cost per health facility strengthened). Personnel costs drove the intervention. This was true regardless of year or activity (i.e. wellness days or events, primary health care strengthening, community engagement, and wellness clubs).
Conclusions: Labor-intensive rather than capital-intensive interventions for low-income settings, like this one, are important for treating and preventing HIV/AIDS and other health conditions sustainably. Over time, costs shifted from international cost centers to in-country headquarters offices, as required for sustainable PEPFAR initiatives. Such costing center evolution reflected changes in the intervention’s composition, including (1) the redesign and re-deployment of service delivery sites according to local needs, uptake, and implementation success and (2) the flexible and adaptable restructuring of intervention components in response to community needs.

Download data is not yet available.


Marseille E Kevany S. The Cost of Providing Case Management Services to Antiretroviral Patients in Ethiopia. Cost Effectiveness and Resource Allocation. 2010; 9 (18) DOI:

Sweat M, Morin S, Celentano D, Mulawa M, Singh B, Mbwambo J, et al. Community-based intervention to increase HIV testing and case detection in people aged 16-32 years in Tanzania, Zimbabwe, and Thailand (NIMH Project Accept, HPTN 043): a randomised study. Lancet Infect Dis. 2011; 11(7): 525-32. DOI:

Padian N, McCoy S, Manian S, Wilson D, Schwartlander B, Bertozzi SM. Evaluation of large-scale combination HIV prevention programs: essential issues. J Acquir Immune Defic Syndr; 58(2): e23-8. DOI:

PEPFAR (2014). Country Ownership. Accessible through:

Merson M, Padian N, Coates T, Gupta G, Bertozzi S, Piot P, et al. Combination HIV prevention. The Lancet. 2008; 372(9652): 1805-6. DOI:

Khumalo-Sakutukwa G ea. Project Accept: A community-based intervention to reduce HIV incidence in Populations at Risk for HIV in sub-Saharan Africa and Thailand. J Acquir Immune Defic Syndr. 2008; 49(4): 422-431.

Rotheram-Borus MJ SD, Chovnick G. The Past, Present, and Future of HIV Prevention: Integrating Behavioral, Biomedical, and Structural Intervention Strategies for the Next Generation of HIV Prevention. Annu Rev Clin Psychol. 2009; 5: 143-167. DOI:

National Strategic Plan for HIV and AIDS, STIs, and TB, 2012-2016. South African Government; 2011.

Comprehensive Management and Control of Sexually Transmitted Infections. In. South Africa; 2010.

Novotny T, Adams,V. Global health diplomacy—A call for a new field of teaching and research. San Francisco Medicine. 2007; 80(3): 22–23.

Khumalo-Sakutukwa G, Morin S, Fritz K, Charlebois E, Van Rooyen H, Chingono A, Coates T Project Accept (HPTN 043): A community-based intervention to reduce HIV incidence in populations at risk for HIV in sub-Saharan Africa and Thailand. JAIDS – Journal of Acquired Immune Deficiency Syndromes. (2008); 49(4): 422–431. DOI:

Feldbaum H, Michaud J. Health diplomacy and the enduring relevance of foreign policy interests. PLoS Medicine. 2010; 7(4). Retrieved from DOI:

Marseille E, Khan J. HIV prevention before HAART in sub-Saharan Africa. The Lancet, 2002; 359: 1851–1856. DOI:

Venter C. Raising the CD4 initiation threshold with our eyes wide open. South African Medical Journal. 2013; 103 (11). DOI:

Goosby E. PEPFAR's commitment to country ownership and achieving an AIDS-free generation. Lancet Glob Health. 2014; Jan;2(1):e18. doi: 10.1016/S2214-109X(13)70156-6 DOI:

Lippman S, Treves-Kagan S, Gilvydis J, et al. Informing comprehensive HIV prevention: a situational analysis of the HIV prevention and care context, North West Province South Africa. 2014. DOI:

Creese A, Floyd K, Alban A, Guinness, L. 2002. Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence. The Lancet. 2003; 59(9318): 1635-1642. DOI:

Granich R, Gilks C, Dye C, De Cock K, Williams B, 2009. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. The Lancet. 2009; 373(9657): 48-57. DOI:

Sweat M, Gregorich S, Sangiwa G, et al. Cost-effectiveness of voluntary HIV-1 counselling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania. The Lancet. 2000;356(9224):113-121.

Menzies N, Abang B, Wanyenze R, et al.. The costs and effectiveness of four HIV counseling and testing strategies in Uganda. Aids. 2009; 23(3): 395-401. DOI:

Lalloo D, Maheswaran H, Petrou S, et al. Economic costs and health-related quality of life outcomes of HIV treatment following self-and facility-based HIV testing in a cluster randomised trial. JAIDS: Journal of Acquired Immune Deficiency Syndromes. 2017. DOI:

Mangenah C, Cowan F, Weiss H, et al. Evaluating a multi-component, community-based program to improve adherence and retention in care among adolescents living with HIV in Zimbabwe: study protocol for a cluster randomized controlled trial. Trials. 2017; 18(1): 4 DOI:

Maheswaran H, Clarke A, MacPherson,P, et al..Cost-effectiveness of community-based HIV self-testing in Blantyre, Malawi. Clinical Infectious Diseases. 2017. DOI:

Mbonigaba J, Oumar, S.. The cost-effectiveness of major HIV/AIDS interventions in rural and urban areas in South Africa. International Journal of Economics and Business Research. 2017; 13(4): 413-434. DOI:

Schneider, H., Blaauw, D., Gilson, L., Chabikuli, N., & Goudge, J. (2006). Health systems and access to antiretroviral drugs for HIV in Southern Africa: service delivery and human resources challenges. Reproductive health matters, 14(27), 12-23. DOI:

Ekwueme, D. U., Pinkerton, S. D., Holtgrave, D. R., & Branson, B. M. (2003). Cost comparison of three HIV counseling and testing technologies. American journal of preventive medicine, 25(2), 112-121. DOI:

Sweat, M., Gregorich, S., Sangiwa, G., Furlonge, C., Balmer, D., Kamenga, C., ... & Coates, T. (2000). Cost-effectiveness of voluntary HIV-1 counselling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania. The lancet, 356(9224), 113-121. DOI:

Coates, T. J., Kulich, M., Celentano, D. D., Zelaya, C. E., Chariyalertsak, S., Chingono, A., ... & Sweat, M. (2014). Effect of community-based voluntary counselling and testing on HIV incidence and social and behavioural outcomes (NIMH Project Accept; HPTN 043): a cluster-randomised trial. The lancet global health, 2(5), e267-e277. DOI:

Kevany, S. (2015). Global Health Diplomacy,“San Francisco Values,” and HIV/AIDS: From the Local to the Global. Annals of global health, 81(5), 611-617. DOI:

Zachariah, R., Harries, A. D., Manzi, M., Gomani, P., Teck, R., Phillips, M., & Firmenich, P. (2006). Acceptance of anti-retroviral therapy among patients infected with HIV and tuberculosis in rural Malawi is low and associated with cost of transport. PloS one, 1(1), e121. DOI:

Chamie, G., Kwarisiima, D., Clark, T. D., Kabami, J., Jain, V., Geng, E., ... & Charlebois, E. D. (2012). Leveraging rapid community-based HIV testing campaigns for non-communicable diseases in rural Uganda. PloS one, 7(8), e43400. DOI:

Jamison, D. T., Breman, J. G., Measham, A. R., Alleyne, G., Claeson, M., Evans, D. B., ... & Musgrove, P. (Eds.). (2006). Disease control priorities in developing countries. World Bank Publications. DOI:




How to Cite

Kevany, S. (2022). Sub-district costs and efficiency of a combination HIV/AIDS prevention-intervention in the Northwest Province of South Africa. Journal of Public Health in Africa, 13(3).



Original Articles