One of PANCEA's primary purposes is to document the outputs of HIV prevention interventions and the associated expenditures. We want to know how much it costs to provide selected HIV prevention services, and to identify the factors determining efficiency and quality. PANCEA employs four types of instruments to provide this information. Several instruments (ARQ, Exit Interviews and the first portion of HIPPI) provide basic information on program operation over one year, and are administered at all PANCEA programs. Others (ADC and the second part of HIPPI) obtain detailed data over a longer time period, and are administered at about 20% of sites. A full description of each instrument is included in the manual. Summaries are presented here.
From each of the ~190 intervention programs we are collecting time-limited cost and output information, using an "abbreviated" data collection protocol. The ARQ instruments span 13 months: the most recent completed fiscal year (by month or by quarter) plus the most recent month. These data are used to generate point estimates of efficiency (cost per prevention service delivered) and cost-effectiveness (cost per HIV infection averted, to be calculated in conjunction with epidemic modeling). The ARQ also collects data on potential determinants of efficiency. These data are used with cost and output data to construct an econometric model that assesses variation in program efficiency. There are two types of ARQ instruments, the ARQni and the intervention-specific ARQ. The ARQ instruments are available below in both Excel and Access.
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| ARQni (non-intervention)|
This instrument gathers comprehensive cost data and other information related to the program's organization, operations, governance and physical plant. It is not specific to any intervention type. Half of the items in ARQni focus on facility characteristics, including organizational context, governance and physical attributes. The other half focus on expenditures, both for the facility and specifically used for the HIV prevention intervention(s) of interest to PANCEA. Expenditure data are classified into five categories: Buildings; personnel, recurring goods; recurring services; and capital goods.
| ARQ (intervention-specific)|
There are 8 ARQ intervention-specific instruments corresponding to the eight interventions examined by PANCEA. These instruments gather data on intervention outputs and on characteristics of the intervention itself. Thus, for a VCT program, ARQni gathers information on costs, while ARQvct gathers information on the number of counseling sessions and HIV tests. ARQvct also collects information on a wide range of potential determinants of efficiency, such as the duration of pre-test counseling, the number of clients in each session, and the type of HIV test used.
| ADC (both intervention-specific and non-intervention-specific)|
The ADC instruments are used to collect cost and output data over the full history of a subset of approximately 50 prevention programs. Like the ARQ, the ADC instruments include both a non-intervention specific version and eight intervention-specific versions. However, unlike the ARQ instruments, the ADC is designed to compile data for a long period of time--specifically a subset of ARQ data from the program's inception (or as far back as good data are available) through the present. The ADC instruments focus on PANCEA's selected HIV prevention interventions only, and do not gather facility information. The ADC instruments are available in Excel only.
This structured open-ended interview elicits information about the prevention program's approach and operational experiences. A short version of HIPPI (HIPPI-1) consists of the first 8 items of the questionnaire and is administered in all sites. It asks about the program's mission, history, and components, as well as the challenges, obstacles and accomplishments of the program. An additional 50 items are administered in HIPPI-2 for the 55 intensive data collection sites. The additional questions address perceptions of the causes of measured high or low efficiency and fluctuations in expenditures or outputs over time. By providing a rich narrative context, findings from HIPPI help inform our understanding of the cost-effectiveness of individual programs and will provide hypothesis for testing in the econometric analyses. HIPPI is implemented in Word.
| Exit Interviews|
Client-perceived quality is an important influence on demand for services and thus potentially on efficiency. We administer exit interviews to 15-20 randomly-selected clients at each intervention site. The exit interviews provide data on clients' socio-economic characteristics such as income and educational level, the time and money required to access services, and their satisfaction with those services. These exit interviews provide an important alternative to the perspective of program staff. The exit interview is implemented in Excel and consists of close-ended questions that take about 10 minutes to administer.