Costs of Streamlined HIV Care Delivery in Rural Ugandan and Kenyan Clinics in the SEARCH Study

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dc.contributor.authorShade, Starley B.
dc.contributor.authorOsmand, Thomas
dc.contributor.authorAine, Ronald
dc.contributor.authorMwebaza, Betty
dc.contributor.authorOwaraganise, Asiphas
dc.contributor.authorMwangwa, Florence
dc.contributor.authorKwarisiima, Dalsone
dc.contributor.authorBukusi, Elizabeth A.
dc.contributor.authorKamya, Moses R.
dc.contributor.authorPetersenk, Maya L.
dc.contributor.authorHavlir, Diane V.
dc.contributor.authorJain, Vivek
dc.date.accessioned2022-08-23T20:21:52Z
dc.date.available2022-08-23T20:21:52Z
dc.date.issued2018
dc.description.abstractAs 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. 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. 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. 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.en_US
dc.identifier.citationShade, S. B., Osmand, T., Luo, A., Aine, R., Assurah, E., Mwebaza, B., ... & Jain, V. (2018). Costs of streamlined HIV care delivery in rural Ugandan and Kenyan clinics in the SEARCH Studys. AIDS (London, England), 32(15), 2179.https://doi.org/10.1097%2FQAD.0000000000001958en_US
dc.identifier.issn0269-9370
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/4395
dc.language.isoenen_US
dc.publisherAIDSen_US
dc.subjectdifferentiated care, HIV antiretroviral therapy, micro-costing, streamlined careen_US
dc.titleCosts of Streamlined HIV Care Delivery in Rural Ugandan and Kenyan Clinics in the SEARCH Studyen_US
dc.typeArticleen_US
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