Costing the Preventing Mother-to-Child Transmission (PMTCT) Response: Update from Ukraine
Initially confined to a concentrated population, the spread of HIV in Ukraine now outpaces the rest of Europe. 1.5 per cent of young men and 1.5 per cent of young women (15-24 years) in Ukraine now live with HIV (UNAIDS, 2008). This has implications for the health and welfare of young people and their children. Hard-won gains in the prevention of transmission from mother to child (brought down to 6.2 per cent in 2008) risk being eroded. The national scale up of PMTCT, informed by sound estimates of the funding needed to deliver the associated services, will be critical as Ukraine undertakes the planning and action necessary to keep its children healthy and well. The response Ukraine has been chosen among 5 countries (Rwanda, Namibia, Nigeria, China, and Cote d’Ivoire) to participate in a global exercise to estimate and review unit costs associated with PMTCT and paediatric treatment and care. The Ukrainian experience will illustrate the needs of a middle- income country with a concentrated HIV and AIDS epidemic. This exercise, spearheaded by UNICEF and the University of Bordeaux, France, is part of a global effort to scale up PMTCT and paediatric care and eliminate HIV and AIDS among children. Objectives of the Costing Exercise in Ukraine A first of its kind in this region, this exercise will deliver vital costing tools to national and international policy-makers and programme imple- menters. It has the potential to provide critical information, including: the human and monetary costs of an intervention and the price of inac- tion; economic feasibility and sustainability of PMTCT, and paediatric HIV treatment and care services. It is expected to have implications on budgeting and planning processes that will inform the nation’s future PMTCT programmes. Specifically, the tool will support the National HIV/ AIDS Programme (2009-2013) to reduce MTCT to less then 2 per cent by 2013, and ensure that all children who need ART receive it. To facilitate the development of the tool, project leads met on the 25th of January in Kiev with a number of national and international stakeholders to review locally-adapted costing tools and initiate the process of data collection with national data collectors. Stakeholder and partners alike have already responded enthusiastically to the tool’s potential to accelerate the PMTCT and Paediatric response. “Our approach is quite innovative as it takes into account not only the costs of antiretroviral drugs but all of the expenditures incurred during the provision of services. It is an ingredient-based approach using a bottom-up methodology, meaning that data gathered from the point of service will be matched to data on cost incurred for provision of services, taking into account: human resources, antiretrovirals (including transportation costs), and commodities being used for necessary lab tests. At the end of the exercise, the goal is to come up with the most up-to-date information on the actual cost of providing universal access to PMTCT services,” says Dr. Hapsatou Toure, Institute of Public Health, Epidemiology and Development, University of Bordeaux. Next Steps Data and findings from the Consultation will inform the broad global costing exercise. The Ukrainian Ministry of Health will also use relevant findings to apply for Global Fund Round 10 and leverage other resources. This article was jointly prepared by Svetlana Ancker and Tetyana Tarasova. Read more on the UniteForChildren website
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