HIV Prevention Costs and Program Scale: Data from the PANCEA Project in Five Low- and Middle-Income Countries

This study analyzed cost and output data from over 200 HIV prevention programs across India, Mexico, Russia, South Africa, and Uganda to answer a basic but important question: does it get cheaper, per person served, to run an HIV prevention program as it grows bigger? The answer was yes almost everywhere the researchers looked, a finding with major implications for how donors and governments should plan and fund the global scale-up of HIV prevention efforts.

• Across nearly every country and program type studied (counseling and testing, sex worker outreach, treatment for sexually transmitted infections, media campaigns, needle exchange, and mother-to-child transmission prevention), larger programs consistently cost less per person served than smaller ones.
• On average, doubling the size of a program cut its cost per person served by about a third, though the size of that saving varied widely, from as little as 2% in some countries to well over 50% in others.
• Only two of the fifteen country-and-program combinations studied showed costs eventually rising again after a certain size, suggesting that most programs examined hadn’t yet hit a point of “too big” inefficiency, encouraging news for global scale-up efforts.
• The study found no meaningful link between program quality and cost, meaning bigger, cheaper-per-person programs weren’t simply cutting corners; the savings likely come from spreading fixed costs over more people served and staff getting more efficient with experience.