Cost analysis of integrated genderaffirming and sexual health services for transgender women in Thailand: Evidence from the Tangerine Clinic

Background: Transgender women experience a disproportionate burden of human immunodeficiency virus (HIV) globally and in Thailand. Integrating gender-affirming care into sexual health services may improve uptake of HIV and sexually transmitted infections (STIs) testing, treatment, and prevention. Cost data are essential to inform program planning and policy decisions regarding inclusion of such services within Thailand’s Universal Health Coverage (UHC) system. Objectives: To estimate the full and unit costs of trans-led, integrated gender-affirming and sexual health services along the HIV care cascade. Methods: Costs of Tangerine Clinic services in 2021 were assessed from the provider perspective, using standard and activity-based costing methods. Data sources included clinic financial records, service utilization databases, and semistructured interviews. Results: The total operating cost of the clinic was Thai Baht (THB) 10.84 million (USD 338,693). Key unit costs were THB 650 (USD 20.32) for HIV testing, THB 2,651 (USD 82.87) per HIV case detected, and THB 1,217 (USD 38.03) for treatment. Prevention costs were THB 4,822 (USD 150.72) for post-exposure prophylaxis, THB 7,322 (USD 228.88) for 6-month preexposure prophylaxis (PrEP), and THB 12,810 (USD 400.42) for 12-month PrEP. Gender-affirming care added a minimal cost of THB 482 (USD 15.05) per test. Conclusion: Integrating genderaffirming care incurred minimal additional cost while supporting HIV/STI service delivery. Despite COVID-19-related service disruptions, the findings provide policy-relevant evidence to inform consideration of integrated services for transgender populations under UHC.