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Cost and outcomes of routine HIV care and treatment: public and private service delivery models covering low-income earners in South Africa

BACKGROUND: While South Africa’s national HIV program is the largest in the world, it has yet to reach the UNAIDS 95–95-95 targets. To reach these targets, the expansion of the HIV treatment program may be accelerated through the use private sector delivery models. This study identified three innova...

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Autores principales: Long, L. C., Girdwood, S., Govender, K., Meyer-Rath, G., Miot, J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10007767/
https://www.ncbi.nlm.nih.gov/pubmed/36906559
http://dx.doi.org/10.1186/s12913-023-09147-7
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author Long, L. C.
Girdwood, S.
Govender, K.
Meyer-Rath, G.
Miot, J.
author_facet Long, L. C.
Girdwood, S.
Govender, K.
Meyer-Rath, G.
Miot, J.
author_sort Long, L. C.
collection PubMed
description BACKGROUND: While South Africa’s national HIV program is the largest in the world, it has yet to reach the UNAIDS 95–95-95 targets. To reach these targets, the expansion of the HIV treatment program may be accelerated through the use private sector delivery models. This study identified three innovative non-governmental primary health care models (private sector) providing HIV treatment, as well as two government primary health clinics (public sector) that served similar populations. We estimated the resources used, and costs and outcomes of HIV treatment across these models to provide inputs to inform decisions around how these services might best be provided through National Health Insurance (NHI). METHODS: A review of potential private sector models for HIV treatment in a primary health care setting was conducted. Models actively offering HIV treatment (i.e. in 2019) were considered for inclusion in the evaluation, subject to data availability and location. These models were augmented by government primary health clinics offering HIV services in similar locations. We conducted a cost-outcomes analysis by collecting patient-level resource usage and treatment outcomes through retrospective medical record reviews and a bottom-up micro-costing from the provider perspective (public or private payer). Patient outcomes were based on whether the patient was still in care at the end of the follow up period and viral load (VL) status, to create the following outcome categories: in care and responding (VL suppressed), in care and not responding (VL unsuppressed), in care (VL unknown) and not in care (LTFU or deceased). Data collection was conducted in 2019 and reflects services provided during the 4 years prior to that (2016–2019). RESULTS: Three hundred seventy-six patients were included across the five HIV treatment models. Across the three private sector models there were differences in the costs and outcomes of HIV treatment delivery, two of the models had results similar to the public sector primary health clinics. The nurse-led model appears to have a cost-outcome profile distinct from the others. CONCLUSION: The results show that across the private sector models studied the costs and outcomes of HIV treatment delivery vary, yet there were models that provided costs and outcomes similar to those found with public sector delivery. Offering HIV treatment under NHI through private delivery models could therefore be an option to increase access beyond the current public sector capacity.
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spelling pubmed-100077672023-03-12 Cost and outcomes of routine HIV care and treatment: public and private service delivery models covering low-income earners in South Africa Long, L. C. Girdwood, S. Govender, K. Meyer-Rath, G. Miot, J. BMC Health Serv Res Research BACKGROUND: While South Africa’s national HIV program is the largest in the world, it has yet to reach the UNAIDS 95–95-95 targets. To reach these targets, the expansion of the HIV treatment program may be accelerated through the use private sector delivery models. This study identified three innovative non-governmental primary health care models (private sector) providing HIV treatment, as well as two government primary health clinics (public sector) that served similar populations. We estimated the resources used, and costs and outcomes of HIV treatment across these models to provide inputs to inform decisions around how these services might best be provided through National Health Insurance (NHI). METHODS: A review of potential private sector models for HIV treatment in a primary health care setting was conducted. Models actively offering HIV treatment (i.e. in 2019) were considered for inclusion in the evaluation, subject to data availability and location. These models were augmented by government primary health clinics offering HIV services in similar locations. We conducted a cost-outcomes analysis by collecting patient-level resource usage and treatment outcomes through retrospective medical record reviews and a bottom-up micro-costing from the provider perspective (public or private payer). Patient outcomes were based on whether the patient was still in care at the end of the follow up period and viral load (VL) status, to create the following outcome categories: in care and responding (VL suppressed), in care and not responding (VL unsuppressed), in care (VL unknown) and not in care (LTFU or deceased). Data collection was conducted in 2019 and reflects services provided during the 4 years prior to that (2016–2019). RESULTS: Three hundred seventy-six patients were included across the five HIV treatment models. Across the three private sector models there were differences in the costs and outcomes of HIV treatment delivery, two of the models had results similar to the public sector primary health clinics. The nurse-led model appears to have a cost-outcome profile distinct from the others. CONCLUSION: The results show that across the private sector models studied the costs and outcomes of HIV treatment delivery vary, yet there were models that provided costs and outcomes similar to those found with public sector delivery. Offering HIV treatment under NHI through private delivery models could therefore be an option to increase access beyond the current public sector capacity. BioMed Central 2023-03-11 /pmc/articles/PMC10007767/ /pubmed/36906559 http://dx.doi.org/10.1186/s12913-023-09147-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Long, L. C.
Girdwood, S.
Govender, K.
Meyer-Rath, G.
Miot, J.
Cost and outcomes of routine HIV care and treatment: public and private service delivery models covering low-income earners in South Africa
title Cost and outcomes of routine HIV care and treatment: public and private service delivery models covering low-income earners in South Africa
title_full Cost and outcomes of routine HIV care and treatment: public and private service delivery models covering low-income earners in South Africa
title_fullStr Cost and outcomes of routine HIV care and treatment: public and private service delivery models covering low-income earners in South Africa
title_full_unstemmed Cost and outcomes of routine HIV care and treatment: public and private service delivery models covering low-income earners in South Africa
title_short Cost and outcomes of routine HIV care and treatment: public and private service delivery models covering low-income earners in South Africa
title_sort cost and outcomes of routine hiv care and treatment: public and private service delivery models covering low-income earners in south africa
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10007767/
https://www.ncbi.nlm.nih.gov/pubmed/36906559
http://dx.doi.org/10.1186/s12913-023-09147-7
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