MOAE0301 | COST ANALYSIS OF HIV VIRAL LOAD TESTING IN PUBLIC AND PRIVATE LABORATORIES: A STUDY IN NIGERIA

Ughweroghene Omo-Emmanuel¹, Victor Obianeri¹, Pamela Gado¹, Augustine Idemudia¹, Chika Okafo-Obiora¹, Peter Egena¹, Dolapo Ogundehin¹, Omosalewa Oyelaran¹, Jemeh Pius¹, Ezekiel James¹, Monday Danung², Olaiton Achor², Ngozi Ezema², Omolara Emmanuel³ | ¹United States Agency For International Development, Abuja, Nigeria; ²Family Health International, Abuja, Nigeria; ³National AIDS, Sexually Transmitted Infections Control and Hepatitis Programme, Abuja, Nigeria

HIV viral load testing (HVLT) is essential for effective HIV management and prevention. In Nigeria, public laboratories (PUL) are the primary providers of HVLT, but they often face systemic bottlenecks that limit access. USAID is leveraging private laboratories (PRL) to help address these challenges. There has been little research comparing the cost structures of HVLT in PRL and PUL settings, especially when it comes to how supply costs affect them. A deeper understanding of these differences is critical to inform policies aimed at expanding affordable access to HVLT. We report on a pilot using a PRL to support HVLT in 26 health facilities across Adamawa State, Nigeria (June 2023–September 2024). We conducted a retrospective, activity-based comparative cost analysis of HVLT in both PRL and PUL settings. Data were collected on total cost per client, including labor, supplies, and equipment, with a focus on the cost of test kits. Cost data were obtained from Zankli Medical Center, Abuja (a PRL that participated in the HVLT pilot) and University of Maiduguri Teaching Hospital (a PUL). Data were entered into Excel, cleaned, analyzed, and expressed in USD and percentages. There were significant cost differences between the sectors (p<0.005). The total cost per client in PRL was USD 8.13, nearly twice the USD 4.33 in PULs. In both settings, supplies constituted the largest share of costs: 98.7% (USD 8.03) in PRL and 95.3% (USD 4.13) in PULs. Notably, the HVL amplification kits used in PRL cost USD 5.85 per test, almost double the USD 2.78 in PULs. Labor and equipment costs were lower in PRLs. However, PULs benefited from global price negotiations and import duty waivers, which substantially reduced their supply costs. This analysis indicates that the predominant costs associated with HIV testing in PRL are attributable to the elevated expenses of supplies, underscoring the necessity for cost optimization strategies in this domain. The findings demonstrate the need for strategic resource allocation and cost-control measures to expand access to HVLT in both sectors, ultimately improving HIV care and public health outcomes in Nigeria.