# Assessing the cost implications of integrating and scaling up HIV services for key populations in Kenya and Malawi

## TL;DR

This study explores how to make HIV services more efficient for key populations in Kenya and Malawi by analyzing cost implications of service volume and integration.

## Contribution

The study introduces new insights into how scaling up and integrating HIV services can lead to cost efficiencies for key populations.

## Key findings

- Increasing service volume leads to higher total costs, but less than proportionally, suggesting economies of scale.
- Integrating HIV services is associated with lower total costs for certain service combinations.
- The findings suggest that strategic service delivery configurations can improve efficiency for key populations.

## Abstract

Limited research has been conducted on strategies to improve the efficiency of HIV services for key populations (KPs). This study investigates ways to enhance healthcare delivery efficiency, focusing on HIV services for KPs. We explore two strategies: expanding service volume and offering multiple HIV services within a single health facility. Using data from the Linkages Across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) program in Kenya and Malawi, we exploit the variation in services provided to assess correlations between different service delivery configurations and their costs. We apply log-log fixed-effects regression models to analyze relationships between the total costs of four HIV services and the volume and range of services delivered. We find that service volume increases correlate with higher total costs, albeit less than proportionally, consistent with possible economies of scale. Negative correlations between service integration and total costs suggest that integrating HIV services for KPs could lead to reduced total costs for some service combinations. These results indicate potential strategies to increase the efficiency of HIV services for KPs, which can inform strategic planning and program execution in Kenya, Malawi, and similar countries.