Methods: A retrospective activity-based costing was performed of EPOA targeting men who have sex with men and transgender people in Krishna district, India. During June-November 2017, 648 coupons were distributed, 353 clients were tested, 69 (19.5%) were diagnosed with HIV, and 59 (86% of individuals diagnosed) were linked to antiretroviral therapy (ART). Project-related expenses (personnel, training, supervision, office, and travel) were captured from financial records and analysed using Excel. In addition, costs were estimated for a replication model of EPOA integrated into the national program, avoiding additional human resource (HR) and office costs.

 

Results: The overall cost of EPOA was US$13,057. The unit cost for distribution of coupons was US$20; testing clients was US$37; diagnosing HIV-positive individuals was US$18; and linking HIV-positive individuals to ART was US$221. HR and office costs accounted for 80% of the total EPOA cost. In the

replication model, the estimated total cost was US$2,701: US$4 for distributing each coupon, US$8 for testing, US$39 for detecting HIV-positive individuals, and US$46 for ART linkage.

 

Conclusion: The longitudinal cost data and case detection rate argue for integrating EPOA into the national program for the KP, to maximize and sustain its benefits. Optimizing resource allocation and task shifting would facilitate the integration process.