Cost-effectiveness of staff and workload profiles in retaining patients on antiretroviral therapy in KwaZulu-Natal, South Africa

Vella, Venanzio; Govender, Thiloshini; Dlamini, Siphiwe N.; Moodley, Indres; David, Verona; Taylor, Myra; Jinabhai, C C

doi:10.1080/09540121.2011.554517

Cited by 10 publications

(19 citation statements)

References 23 publications

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“…Out of 574 abstracts retrieved, 150 full-text studies were assessed for eligibility; of those, 29 were included in analysis: 26 on ART (23 on adult ART, two on adult and pediatric ART [21, 22] , and one on pediatric ART only) [23] (tables I, II and III). Table IV provides results for the base case and the sensitivity analysis for ART unit costs, and fig.…”

Section: Resultsmentioning

confidence: 99%

“…[22, 24–28] Studies for lower-middle-income countries (LMIC) were found for India [29, 30] , Lesotho [18] , Morocco [31] , Nigeria [32, 33] , and Thailand [34] ; the median cost of ART was $932 (mean $1,246, range $156 to $3,904) (tables II & IV). In upper-middle-income countries (UMIC), Brazil [23, 35] , Mexico [36–38] and South Africa [21, 39–45] the median ART cost was $1,454 (mean $2,783; range $1,230 to $5,667) (tables III & IV). …”

Section: Resultsmentioning

confidence: 99%

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Unit Costs for Delivery of Antiretroviral Treatment and Prevention of Mother-to-Child Transmission of HIV

et al. 2011

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Background As antiretroviral treatment (ART) for HIV/AIDS is scaled-up globally, information on per-person costs is critical to improve efficiency in service delivery and maximize coverage and health impact. Objective To review studies on delivery unit costs for adult and pediatric ART provision per-patient-year, and prevention of mother-to-child transmission (PMTCT) interventions per mother-infant pair screened or treated, in low- and middle-income countries. Methods Systematic review of English, French and Spanish publications from 2001 to 2009, reporting empirical costing that accounted for at least antiretroviral (ARV) medicines, laboratory testing and personnel. Expenditures were analyzed by country income level and cost component. All costs were standardized to 2009 US dollars. Results Analyses covered 29 eligible, comprehensive costing studies. In the base case, in low-income countries (LIC), median, ART cost per patient-year was $792 (mean: $839, range: $682-$1089); for lower-middle-income countries (LMIC), the median was $932 (mean: $1246, range: $156-$3904); and for upper-middle-income countries (UMIC) the median was $1454 (mean: $2783, range: $1230-$5667). ARV drugs were largest component of overall ART cost in all settings (62%, 50% and 47% in LIC, LMIC and UMIC respectively). Out of 26 ART studies, 14 report which drug regimes were used, and only one study explicitly reported second line treatment costs. The second cost driver was laboratory cost in LIC and LMIC (14% and 19.5%) whereas it was personnel costs in UMIC (26%). Two studies specified the types of laboratory tests costed, and three studies specifically included above-facility-level personnel costs. Three studies reported detailed PMTCT costs, and two studies reported on pediatric ART. Conclusions There is a paucity of data on the full ART and PMTCT delivery unit costs, in particular for low-and middle-income countries. Heterogeneity in activities costed and insufficient detail regarding components included in the costing hampers standardization of unit cost measures. Evaluation of program-level unit costs would benefit from international guidance on standardized costing methods, and expenditure categories and definitions. Future work should help elucidate the sources for the large variations in delivery unit costs across settings with similar income and epidemiological characteristics.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Unit Costs for Delivery of Antiretroviral Treatment and Prevention of Mother-to-Child Transmission of HIV

et al. 2011

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“…Of those examining provider or facility interventions [13], we found only one that evaluated an adherence improvement strategy in a low-income country setting [14]. In Nicaragua, only one study has examined economic issues of HIV care: a cost analysis of centralized viral load testing [15].…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Improving Health Care to People with HIV in Nicaragua

Broughton

Nunez

Moreno

2014

Nursing Research and Practice

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Background. A 2010 evaluation found generally poor outcomes among HIV patients on antiretroviral therapy in Nicaragua. We evaluated an intervention to improve HIV nursing services in hospital outpatient departments to improve patient treatment and retention in care. The intervention included improving patient tracking, extending clinic hours, caring for children of HIV+ mothers, ensuring medication availability, promoting self-help groups and family involvement, and coordinating multidisciplinary care. Methods. This pre/postintervention study examined opportunistic infections and clinical status of HIV patients before and after implementation of changes to the system of nursing care. Hospital expenditure data were collected by auditors and hospital teams tracked intervention expenses. Decision tree analysis determined incremental cost-effectiveness from the implementers' perspective. Results. Opportunistic infections decreased by 24% (95% CI: 14%–34%) and 11.3% of patients improved in CDC clinical stage. Average per-patient costs decreased by $133/patient/year (95% CI: $29–$249). The intervention, compared to business-as-usual strategy, saved money while improving outcomes. Conclusions. Improved efficiency of services can allow more ART-eligible patients to receive therapy. We recommended the intervention be implemented in all HIV service facilities in Nicaragua.

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“…Recent research 4,5 (Garrido: submitted for publication) shows that contact with TB patients (in the same household, neighborhood, workplace, or hospital) is an important risk factor that requires investigation for MDR-TB at the beginning of treatment. Therefore, sputum culture, strain identification, and sensitivity testing should all be included in the list of priorities of the National Tuberculosis Control Program in order to break the chain of transmission 10 .…”

Section: Case Reportmentioning

confidence: 99%

“…In the transmission of resistant strains, the greatest individual risk factor is sharing living quarters with individuals who have defaulted on their TB treatment or are relapse cases 4,5 . The appearance of patients with first-line MDR-TB leads to the use of alternative medications, often at higher costs, longer treatment periods, and greater clinical complexity due to the fact that these drugs are injectable and tend to lead to more side effects 6,7 .…”

mentioning

confidence: 99%

Primary multidrug-resistant tuberculosis and its control implications in the State of Amazonas, Brazil: report of 3 cases

Garrido

Talhari

Antunes

et al. 2012

Rev. Soc. Bras. Med. Trop.

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The occurrence of tuberculosis with first-line multidrug resistance leads to the use of alternative medications, often at higher costs, longer treatment periods, and greater clinical complexity. Here, we report 3 patients with multidrug-resistant tuberculosis. One patient with human immunodeficiency virus died before the sensitivity test was performed. The early diagnosis of multidrug-resistant tuberculosis and appropriate treatment should be priorities of the National Tuberculosis Control Program in order to break the chain of transmission. In addition, the possibility of substituting the proportion method with more modern and faster techniques should be urgently evaluated.

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Cost-effectiveness of staff and workload profiles in retaining patients on antiretroviral therapy in KwaZulu-Natal, South Africa

Abstract: The results could be used to estimate the human resources needed for a sustainable scaling up of ART in KZN.

Cited by 10 publications

References 23 publications

Unit Costs for Delivery of Antiretroviral Treatment and Prevention of Mother-to-Child Transmission of HIV

Unit Costs for Delivery of Antiretroviral Treatment and Prevention of Mother-to-Child Transmission of HIV

Cost-Effectiveness of Improving Health Care to People with HIV in Nicaragua

Primary multidrug-resistant tuberculosis and its control implications in the State of Amazonas, Brazil: report of 3 cases

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