Background Avahan, a large-scale HIV prevention programme, provides STI services to over 300,000 high risk individuals (HRIs) in six states of India through six different service delivery models varying by provision site (programme operated vs. contract provider) and use of outreach activities. This study aims to determine the cost-efficiency of alternative STI service delivery models.

Methods Data from the period between January to June 2010 was collected retrospectively from a stratified random sample of 30 selected NGO/CBOs, providing STI services to HRIs. Service statistics were obtained from Avahan’s Computerized Management Information System, and cost data from the NGO/CBOs financial records. Cost and outcome performance from the NGO/CBOs were annualised and standardised to reflect a high risk group size of 1,000. Analysis was done from a service delivery perspective and did not include programme management and outreach activity costs. Incremental cost-effectiveness analysis allows us to identify the most cost-effective NGO/CBO model for STI service delivery.

Results Most of the NGO/CBOs served more than 2,000 HRIs. However, when standardised to reflect a population of 1,000 HRIs, the programme operated clinic with outreach model was able to deliver STI control services at a lower cost per STI consultation, than alternative models. Incremental cost-effectiveness analysis of alternative STI service models with regards to coverage of STI screening & syphilis testing, show this model to be the most cost-effective model.

Conclusions For larger NGO/CBOs, use of outreach is critical to obtain operational efficiencies. Program operated clinics with outreach were found to be the most cost-effective model, probably due to increased access to scattered high-risk populations through effective outreach activities and continuity of care.