Cost of Sauti ya Vijana (SYV), a mental health intervention for young people living with HIV in Tanzania: Results from a pilot randomized controlled trial

Sauti ya Vijana (SYV) is a ten-session, group-based mental health and life skills intervention targeting young people living with HIV (YPLWH) in Tanzania. By addressing mental health distress and promoting self-efficacy and resilience to HIV-related stigma and disclosure, SYV aims to improve adherence to antiretroviral therapy (ART) and virologic suppression. A pilot randomized controlled trial (RCT) of SYV was conducted in Moshi, Tanzania, from April 2016 to August 2020. We aimed to estimate the cost of SYV delivery in the pilot RCT, identify key cost drivers, and inform future scale-up. We used a hybrid costing methodology and an intent-to-treat approach to estimate the cost of SYV delivery in the two-arm pilot RCT. Cost data were obtained from project records and interviews with key project personnel. Our estimates included start-up, service delivery, research-related costs, and program administrative fees. Human resources were costed in terms of full-time equivalents for salaried personnel. Costs are reported in 2022 USD. The pilot study included 58 participants in the SYV arm and 47 in the standard-of-care arm. The total cost to deliver SYV to the 58 participants in the SYV arm was approximately US$137,618·05. The total per-participant cost was US$2,372·72, the total non research cost was US$56,111·70, and the non-research cost per participant was US$967·44. Research-related costs comprised 59·23% (US$81,506·35) of the total cost. The most significant individual drivers of the total cost were research-related ART concentration in hair tests used to measure adherence (US$42,136·43), salaries for group leaders (US$33,607·94), and viral load tests (US$22,385·55). Our findings show that research-related expenses made up over half of the total costs of SYV delivery. Thus, a scale-up of the intervention without the additional trial components for measuring intervention efficacy would have better budgetary implications due to a smaller research footprint. These findings should guide policymakers in expanding SYV and similar mental health interventions for YPLWH.