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Economic evaluation of a cluster randomized, non-inferiority trial of differentiated service delivery models of HIV treatment in Zimbabwe

About 85% of Zimbabwe’s >1.4 million people living with HIV are on antiretroviral treatment (ART). Further expansion of its treatment program will require more efficient use of existing resources. Two promising strategies for reducing resource utilization per patient are multi-month medication di...

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Autores principales: Benade, Mariet, Nichols, Brooke E., Fatti, Geoffrey, Kuchukhidze, Salome, Takarinda, Kudakwashe, Mabhena-Ngorima, Nicoletta, Grimwood, Ashraf, Rosen, Sydney
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021451/
https://www.ncbi.nlm.nih.gov/pubmed/36962960
http://dx.doi.org/10.1371/journal.pgph.0000493
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author Benade, Mariet
Nichols, Brooke E.
Fatti, Geoffrey
Kuchukhidze, Salome
Takarinda, Kudakwashe
Mabhena-Ngorima, Nicoletta
Grimwood, Ashraf
Rosen, Sydney
author_facet Benade, Mariet
Nichols, Brooke E.
Fatti, Geoffrey
Kuchukhidze, Salome
Takarinda, Kudakwashe
Mabhena-Ngorima, Nicoletta
Grimwood, Ashraf
Rosen, Sydney
author_sort Benade, Mariet
collection PubMed
description About 85% of Zimbabwe’s >1.4 million people living with HIV are on antiretroviral treatment (ART). Further expansion of its treatment program will require more efficient use of existing resources. Two promising strategies for reducing resource utilization per patient are multi-month medication dispensing and community-based service delivery. We evaluated the costs to providers and patients of community-based, multi-month ART delivery models in Zimbabwe. We used resource and outcome data from a cluster-randomized non-inferiority trial of three differentiated service delivery (DSD) models targeted to patients stable on ART: 3-month facility-based care (3MF), community ART refill groups (CAGs) with 3-month dispensing (3MC), and CAGs with 6-month dispensing (6MC). Using local unit costs, we estimated the annual cost in 2020 USD of providing HIV treatment per patient from the provider and patient perspectives. In the trial, retention at 12 months was 93.0% in the 3MF, 94.8% in the 3MC, and 95.5% in the 6MC arms. The total average annual cost of HIV treatment per patient was $187 (standard deviation $39), $178 ($30), and $167 ($39) in each of the three arms, respectively. The annual cost/patient was dominated by ART medications (79% in 3MF, 87% in 3MC; 92% in 6MC), followed by facility visits (12%, 5%, 5%, respectively) and viral load (8%, 8%, 2%, respectively). When costs were stratified by district, DSD models cost slightly less, with 6MC the least expensive in all districts. Savings were driven by differences in the number of facility visits made/year, as expected, and low uptake of annual viral load tests in the 6-month arm. The total annual cost to patients to obtain HIV care was $10.03 ($2) in the 3MF arm, $5.12 ($0.41) in the 3MC arm, and $4.40 ($0.39) in the 6MF arm. For stable ART patients in Zimbabwe, 3- and 6-month community-based multi-month dispensing models cost less for both providers and patients than 3-month facility-based care and had non-inferior outcomes.
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spelling pubmed-100214512023-03-17 Economic evaluation of a cluster randomized, non-inferiority trial of differentiated service delivery models of HIV treatment in Zimbabwe Benade, Mariet Nichols, Brooke E. Fatti, Geoffrey Kuchukhidze, Salome Takarinda, Kudakwashe Mabhena-Ngorima, Nicoletta Grimwood, Ashraf Rosen, Sydney PLOS Glob Public Health Research Article About 85% of Zimbabwe’s >1.4 million people living with HIV are on antiretroviral treatment (ART). Further expansion of its treatment program will require more efficient use of existing resources. Two promising strategies for reducing resource utilization per patient are multi-month medication dispensing and community-based service delivery. We evaluated the costs to providers and patients of community-based, multi-month ART delivery models in Zimbabwe. We used resource and outcome data from a cluster-randomized non-inferiority trial of three differentiated service delivery (DSD) models targeted to patients stable on ART: 3-month facility-based care (3MF), community ART refill groups (CAGs) with 3-month dispensing (3MC), and CAGs with 6-month dispensing (6MC). Using local unit costs, we estimated the annual cost in 2020 USD of providing HIV treatment per patient from the provider and patient perspectives. In the trial, retention at 12 months was 93.0% in the 3MF, 94.8% in the 3MC, and 95.5% in the 6MC arms. The total average annual cost of HIV treatment per patient was $187 (standard deviation $39), $178 ($30), and $167 ($39) in each of the three arms, respectively. The annual cost/patient was dominated by ART medications (79% in 3MF, 87% in 3MC; 92% in 6MC), followed by facility visits (12%, 5%, 5%, respectively) and viral load (8%, 8%, 2%, respectively). When costs were stratified by district, DSD models cost slightly less, with 6MC the least expensive in all districts. Savings were driven by differences in the number of facility visits made/year, as expected, and low uptake of annual viral load tests in the 6-month arm. The total annual cost to patients to obtain HIV care was $10.03 ($2) in the 3MF arm, $5.12 ($0.41) in the 3MC arm, and $4.40 ($0.39) in the 6MF arm. For stable ART patients in Zimbabwe, 3- and 6-month community-based multi-month dispensing models cost less for both providers and patients than 3-month facility-based care and had non-inferior outcomes. Public Library of Science 2023-03-13 /pmc/articles/PMC10021451/ /pubmed/36962960 http://dx.doi.org/10.1371/journal.pgph.0000493 Text en © 2023 Benade et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Benade, Mariet
Nichols, Brooke E.
Fatti, Geoffrey
Kuchukhidze, Salome
Takarinda, Kudakwashe
Mabhena-Ngorima, Nicoletta
Grimwood, Ashraf
Rosen, Sydney
Economic evaluation of a cluster randomized, non-inferiority trial of differentiated service delivery models of HIV treatment in Zimbabwe
title Economic evaluation of a cluster randomized, non-inferiority trial of differentiated service delivery models of HIV treatment in Zimbabwe
title_full Economic evaluation of a cluster randomized, non-inferiority trial of differentiated service delivery models of HIV treatment in Zimbabwe
title_fullStr Economic evaluation of a cluster randomized, non-inferiority trial of differentiated service delivery models of HIV treatment in Zimbabwe
title_full_unstemmed Economic evaluation of a cluster randomized, non-inferiority trial of differentiated service delivery models of HIV treatment in Zimbabwe
title_short Economic evaluation of a cluster randomized, non-inferiority trial of differentiated service delivery models of HIV treatment in Zimbabwe
title_sort economic evaluation of a cluster randomized, non-inferiority trial of differentiated service delivery models of hiv treatment in zimbabwe
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021451/
https://www.ncbi.nlm.nih.gov/pubmed/36962960
http://dx.doi.org/10.1371/journal.pgph.0000493
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