Sub-district Costs and Efficiency of the Re Mmogo Pholong (“Together in Wellness”) Combination HIV/AIDS Prevention Intervention in the North West Province of South Africa

Background Re Mmogo Pholong (RMP) or “Together in Wellness”), was a combination prevention program to strengthen HIV prevention programming, community support mechanisms, community-based HIV testing, referral systems, and HIV prevention integration at the primary care level, thereby sustainably reducing HIV/AIDS transmission in the North West Province of South Africa. RMP included four overlapping components: situational analysis, community engagement and mobilization, community-based biomedical and behavioral prevention, and primary health care systems strengthening. In support of the PEPFAR country-ownership paradigm, we conducted costing analysis of the RMP combination HIV prevention program to determine data needed for potential transition of to local ownership. Methods We used standard costing methodology for this research. Results We found that cost per unit of output ranged from $63.93 (cost per person reached with individual or small group prevention interventions) to $4,344.88 (cost per health facility strengthened). The RMP intervention was primarily dependent on personnel costs. This was true regardless of the time period (Year 1 vs. Year 2) or activity (i.e. wellness days or events, primary health care strengthening, community engagement, and wellness clubs). Conclusions The development of labor-intensive rather than capital intensive interventions for low-income settings such as RMP was identified as being particularly important in treating and preventing HIV/AIDS and other health conditions in a sustainable manner. Costs were also observed to transition from international cost centers to in-country headquarters offices over time, in keeping with the transition of international to local responsibility required for sustainable PEPFAR initiatives. Such costing center evolution was also reflected by changes in the composition of the intervention, 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.