Community-based delivery of HIV treatment in Zambia: costs and outcomes
OBJECTIVE:To determine the total annual cost per patient treated and total cost per patient retained on antiretroviral therapy in Zambia in conventional care in facilities and across community-based differentiated service delivery (DSD) models. DESIGN:Economic evaluation using retrospective electron...
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Published in | AIDS (London) Vol. 35; no. 2; pp. 299 - 306 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
England
Copyright Wolters Kluwer Health, Inc
02.02.2021
Lippincott Williams & Wilkins |
Subjects | |
Online Access | Get full text |
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Summary: | OBJECTIVE:To determine the total annual cost per patient treated and total cost per patient retained on antiretroviral therapy in Zambia in conventional care in facilities and across community-based differentiated service delivery (DSD) models.
DESIGN:Economic evaluation using retrospective electronic record review.
SETTING:Twenty healthcare facilities (13 with DSD models and 7 as comparison sites) in 6 of Zambiaʼs 10 provinces.
SUBJECTS, PARTICIPANTS:All individuals on ART > 18 years old at the study sites, enrolled in a DSD model or conventional care by site type, respectively, with at least 12 months of follow-up data.
INTERVENTION:Accessing care through DSD models (community adherence groups (CAGs), urban adherence groups (UAGs), home ART delivery and care, and mobile ART services) or facility-based conventional care with 3-monthly visits.
MAIN OUTCOME MEASURES:Total annual cost per patient treated and annual cost per patient retained in care 12 months after model enrolment. Retention in care was defined as attending a clinic visit at 12 months +/- 3 months.
RESULTS:The DSD models assessed cost more per patient/year than conventional care. Costs ranged from an annual $116 to $199 for the DSD models, compared with $100 for conventional care. CAGs and UAGs increased retention by 2% and 14%, respectively. All DSD models cost more per patient retained at 12 months than conventional care. The CAG had the lowest cost/patient retained for DSD models ($140–157).
CONCLUSIONS:Though they achieve equal or improved retention in care, out-of-facility models of ART were more expensive than conventional care. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0269-9370 1473-5571 |
DOI: | 10.1097/QAD.0000000000002737 |