Community-based delivery of HIV treatment in Zambia: costs and outcomes

• Published in: AIDS (London) Vol. 35; no. 2; pp. 299 - 306
• Main Authors: Nichols, Brooke E, Cele, Refiloe, Jamieson, Lise, Long, Lawrence C, Siwale, Zumbe, Banda, Patrick, Moyo, Crispin, Rosen, Sydney
• Format: Journal Article
• Language: English
• Published: England Copyright Wolters Kluwer Health, Inc 02.02.2021; Lippincott Williams & Wilkins
• Subjects: Adolescent; Anti-HIV Agents - therapeutic use; Delivery of Health Care; Epidemiology and Social; Female; HIV Infections - drug therapy; Humans; Male; Retrospective Studies; Zambia; Zambia
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/QAD.0000000000002737

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.