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Trends in Procurement Costs for HIV Commodities: A 7-Year Retrospective Analysis of Global Fund Data Across 125 Countries

Wafula, Francis PhD*; Agweyu, Ambrose MD; Macintyre, Kate PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 1st, 2014 - Volume 65 - Issue 4 - p e134–e139
doi: 10.1097/QAI.0000000000000053
Implementation and Operational Research: Epidemiology and Prevention
IOR articles

Background: Nearly 40% of Global Fund money goes toward procurement. However, no analyses have been published to show how costs vary across regions and time, despite the availability of procurement data collected through the Global Fund's price and quality reporting system.

Methodology: We analyzed data for the 3 most widely procured commodities for the prevention, diagnosis, and treatment of HIV. These were male condoms, HIV rapid tests, and the antiretroviral (ARV) combination of lamivudine/nevirapine/zidovudine. The compared costs, first across time (2005–2012), then across regions, and finally, between individual procurement reported through the price and quality reporting and pooled procurement reported through the Global Fund's voluntary pooled procurement system. All costs were adjusted for inflation and reported in US dollars.

Key Findings: There were 2337 entries from 578 grants in 125 countries. The procurement cost for the ARV dropped substantially over the period, whereas those for condoms and HIV tests remained relatively stable. None of the commodity prices increased. Regional variations were pronounced for HIV tests, but minimal for condoms and the ARV. The unit cost for the 3-table ARV combination, for instance, varied between US$0.15 and US$0.23 in South Asia and the Eastern Europe/Central Asia regions, respectively, compared with a range of $0.23 (South Asia)—$1.50 (Eastern Europe/Central Asia) for a single diagnostic test. Pooled procurement lowered costs for condoms but not the other commodities.

Conclusions: We showed how global procurement costs vary by region and time. Such analyses should be done more often to identify and correct market insufficiencies.

Supplemental Digital Content is Available in the Text.

*Aidspan, Nairobi, Kenya; and

KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya.

Correspondence to: Francis Wafula, PhD, Aidspan, PO Box 66869-00800, Nairobi, Kenya (e-mail:

Aidspan is funded by the UK Department for International Development, the Ford Foundation, GIZ Backup Initiative, Norad and Hivos.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received October 25, 2013

Accepted October 25, 2013

© 2014 by Lippincott Williams & Wilkins