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


AUTHORS

Nichols BE , Cele R , Jamieson L , Long LC , Siwale Z , Banda P , Moyo C , Rosen S , . AIDS (London, England). 2020 11 5; ().

ABSTRACT

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 Zambia’s 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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