Costs of streamlined HIV care delivery in rural Ugandan and Kenyan clinics in the SEARCH Studys
| Autor: | Betty Mwebaza, Thomas Osmand, Asiphas Owaraganise, Dalsone Kwarisiima, Elly Assurah, Ronald Aine, Moses R. Kamya, Craig R. Cohen, Diane V. Havlir, Douglas Black, Daniel Mwai, Harsha Thirumurthy, Elizabeth A. Bukusi, Starley B. Shade, Lillian B. Brown, Vivek Jain, Maya L. Petersen, James Ayieko, Laura B. Balzer, Tamara D. Clark, Florence Mwangwa, Edwin D. Charlebois, Alex Luo |
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| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Rural Population Kenya medicine.medical_specialty Immunology Human immunodeficiency virus (HIV) HIV Infections micro-costing medicine.disease_cause Medical and Health Sciences 03 medical and health sciences 0302 clinical medicine Clinical Research Virology Health care medicine Immunology and Allergy Humans Uganda HIV antiretroviral therapy 030212 general & internal medicine Viral suppression Disease management (health) Fixed cost health care economics and organizations streamlined care business.industry Psychology and Cognitive Sciences 1. No poverty Disease Management differentiated care Health Care Costs Health Services Biological Sciences Clinical Science 030112 virology Antiretroviral therapy 3. Good health Mental Health Good Health and Well Being Infectious Diseases Family medicine Costs and Cost Analysis HIV/AIDS Business Infection Viral load |
| Zdroj: | AIDS (London, England) AIDS (London, England), vol 32, iss 15 |
| ISSN: | 1473-5571 |
| Popis: | Author(s): Shade, Starley B; Osmand, Thomas; Luo, Alex; Aine, Ronald; Assurah, Elly; Mwebaza, Betty; Mwai, Daniel; Owaraganise, Asiphas; Mwangwa, Florence; Ayieko, James; Black, Douglas; Brown, Lillian B; Clark, Tamara D; Kwarisiima, Dalsone; Thirumurthy, Harsha; Cohen, Craig R; Bukusi, Elizabeth A; Charlebois, Edwin D; Balzer, Laura; Kamya, Moses R; Petersen, Maya L; Havlir, Diane V; Jain, Vivek | Abstract: OBJECTIVES/DESIGN:As antiretroviral therapy (ART) rapidly expands in sub-Saharan Africa using new efficient care models, data on costs of these approaches are lacking. We examined costs of a streamlined HIV care delivery model within a large HIV test-and-treat study in Uganda and Kenya. METHODS:We calculated observed per-person-per-year (ppy) costs of streamlined care in 17 health facilities in SEARCH Study intervention communities (NCT: 01864603) via micro-costing techniques, time-and-motion studies, staff interviews, and administrative records. Cost categories included salaries, ART, viral load testing, recurring goods/services, and fixed capital/facility costs. We then modeled costs under three increasingly efficient scale-up scenarios: lowest-cost ART, centralized viral load testing, and governmental healthcare worker salaries. We assessed the relationship between community-specific ART delivery costs, retention in care, and viral suppression. RESULTS:Estimated streamlined HIV care delivery costs were $291/ppy. ART ($117/ppy for TDF/3TC/EFV [40%]) and viral load testing ($110/ppy for 2 tests/year [39%]) dominated costs versus salaries ($51/ppy), recurring costs ($5/ppy), and fixed costs ($7/ppy). Optimized ART scale-up with lowest-cost ART ($100/ppy), annual viral load testing ($24/ppy), and governmental healthcare salaries ($27/ppy), lowered streamlined care cost to $163/ppy. We found clinic-to-clinic heterogeneity in retention and viral suppression levels versus streamlined care delivery costs, but no correlation between cost and either retention or viral suppression. CONCLUSIONS:In the SEARCH Study, streamlined HIV care delivery costs were similar to or lower than prior estimates despite including viral load testing; further optimizations could substantially reduce costs further. These data can inform global strategies for financing ART expansion to achieve UNAIDS 90-90-90 targets. |
| Databáze: | OpenAIRE |
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