The methods used in this study were adapted from our previous studies on cost and efficiency of HIV prevention interventions in the state of Andhra Pradesh [
6,
7,
9,
11,
12]. This report is part of a study on the cost and outputs of HIV prevention programmes that was approved by the Institutional Ethics Committee of the Administrative Staff college of India, Hyderabad, India.
Data collection
Data were collected by investigators who received training to ensure a standardized approach to data collection. Standard data collection instruments were used and a pilot study was completed to make final adjustments to the data collection formats and approach. Data were collected from the written records of the programmes and through semi-structured interviews of NGO staff. This included the programme project director, project manager, accounts officer, sexual health service provider, outreach workers and counselors. Formal consent of the senior-most person responsible for each programme, generally the director of non-governmental organisation, was obtained for data collection. Data included a history of the evolution of the programme, and output and cost measurements for each month for the April 2005 – March 2006 fiscal year.
Outputs data
The total number of individual truck drivers served and the total number of contacts made with them by each programme was documented. According to the programme personnel, a long distance truck driver was defined as a driver or a cleaner who was away from home for more than four continuous days due to work related travel. The National AIDS Control Organisation categorises the services delivered to truck drivers by the HIV prevention programmes into four major components: behaviour change communication (BCC), STI care, condom promotion, and creating an enabling environment [
14]. Information on each of the above services was extracted from the written records. BCC comprises several types of sessions by outreach workers, counselors, sexual health service providers and peer educators to teach and encourage the truck drivers individually and in groups to follow safe sex practices. STI care includes the programme staff identifying syndromic manifestations of disease, subsequent referrals for truck driver treatment that could not be completed on site and for HIV counselling at the nearest counselling and testing center. Additional formal training programmes for new sexual health service providers such as registered and private medical practitioners are also included under the sexual transmitted infection care category. Condom promotion includes free condom distribution and sale of condoms under social marketing. Creating an enabling environment for truck drivers includes sensitization meetings with a variety of external stakeholders. These stakeholders include family members of truck drivers, police, media, truck owners associations and policy makers. These meetings assist in establishing linkages with relevant governmental and non-government organisations which includes referral of HIV positive truck drivers to care and support centers and assistance with some of truck driver non-sexual health needs.
Cost data
Cost data were collected under five categories: salaries, recurrent goods, recurrent services, rentals and capital goods. Economic cost for implementing the HIV prevention programmes was computed rather than just the financial cost, the former being the true resource cost incurred. Similar costing methods were used for all programmes. Indian Rupees (INR) costs were converted into US$ using the average exchange rate of INR 44.27 for a US$ for the April 2005 – March 2006 fiscal year [
15].
The salary costs were recorded for all personnel contributing towards the truck driver programmes. Personnel included the project director, project manager, accounts officer, outreach workers, counselor, and attender. Cash compensation paid by the programme to peer educators was also included in salary costs.
Recurrent goods included condoms, medications for STI, BCC materials, stationery and condom outlet boxes. The majority of condoms distributed to the truck drivers through these programmes were provided free of cost by APSACS. The market price of condoms for free distribution is subsidized by up to 70% by the government. We calculated the economic cost of condoms at the unsubsidized cost. Several brands of condoms are also sold to truck drivers through the condom social marketing programmes at the cost at which these are procured. As these condoms are not subsidized, market price was used for the economic cost calculations. The cost of BCC materials was obtained from APSACS which supplies these to the truck driver programmes.
Recurrent services included expenditures for peer educator meetings, training of peer educators and staff, and programme operational costs which included local travel, organization of awareness programmes, mobile clinic set-up cost, organising special events, office maintenance and various other miscellaneous costs. The cost of training was obtained from APSACS. The cost for staff training was calculated by including travel fare, per diem, trainer fees, training materials, and training facility cost.
The offices of all these programmes run by NGOs were located in rented buildings. The details of the monthly rent paid were obtained from the programme records.
Capital goods included computer and accessories, office furniture, electrical fixtures, telephone, audio visual equipment, television, DVD player, public address system, two-wheeled vehicles and air cooler. An attempt was made to obtain the costs incurred on these from the truck driver programme records. When this not available from the programme, the retail market price was determined for these goods. Three quotations for these goods were obtained from the market for the 2005–2006 fiscal year and the average of these was considered as the cost. The life of the capital goods was assumed to be five years, and therefore, one-fifth of the cost was allocated to the 2005–2006 fiscal year if the good was used for the full year. If a capital good was purchased in the middle of this fiscal year and used only for half the year, the cost allocated for this item was half of the yearly cost.
Data analysis
Data were entered in Microsoft word and excel software, and SPSS version 15.0 was used for data analysis. The average number of contacts made with truck drivers by the programme staff was calculated. The HIV preventions services provided in each of the four HIV prevention service components, i.e. BCC, STI care, condom promotion, and creating an enabling environment, were computed. The number of contacts made with truck drivers by programme staff versus those made by peer educators was compared. The total economic cost for implementing each programme was calculated. The average economic cost per truck driver served in the fiscal year was taken as the main measure of cost-efficiency, and its relation with the total number of truck drivers served assessed using regression analysis. Additionally, the cost per contact with truck driver and its relation with the total number of truck drivers contacted was assessed using regression analysis. The curve estimation regression models available in SPSS (exponential, linear, logarithmic, polynomial, quadratic, cubic and power) were used and the regression forms which yielded the highest R-square values are presented.