Health care costs associated with clinic visits for prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania

Naburi, Helga; Mujinja, Phare; Kilewo, Charles; Biberfeld, Gunnel; Bärnighausen, Till; Manji, Karim; Lyatuu, Goodluck; Urrio, Roseline; Zethraeus, Niklas; Orsini, Nicola; Ekström, Anna Mia

doi:10.1097/md.0000000000027828

Cited by 2 publications

(2 citation statements)

References 32 publications

(73 reference statements)

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“…A large preponderance of these costs was driven by consumables that included medications and labs (61–91% of total costs), followed by human resources (3–22%), indirect costs (2–14%), and space and equipment (1–2%). Our observed pattern of costs is consistent with prior research, including in Tanzania [ 23 – 25 ]. We also observed that costs varied widely across individuals, facilities, and service lines, and that these were partially explained by patient- and facility-level characteristics.…”

Section: Discussionsupporting

confidence: 92%

National Evaluation of HIV Service Resource Allocation in Tanzania

et al. 2023

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Using time-driven activity-based costing (TDABC), we examined resource allocation and costs for HIV services throughout Tanzania at patient and facility levels. This national, cross-sectional analysis of 22 health facilities quantified costs and resources associated with 886 patients receiving care for five HIV services: antiretroviral therapy, prevention of mother-to-child transmission, HIV testing and counseling, voluntary medical male circumcision, and pre-exposure prophylaxis. We also documented total provider-patient interaction time, the cost of services with and without inclusion of consumables, and conducted fixed-effects multivariable regression analyses to examine patient- and facility-level correlates of costs and provider-patient time. Findings showed that resources and costs for HIV care varied significantly throughout Tanzania, including as a function of patient- and facility-level characteristics. While some variation may be preferable (e.g., needier patients received more resources), other areas suggested a lack of equity (e.g., wealthier patients received more provider time) and presented opportunities to optimize care delivery protocols.

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Section: Discussionsupporting

confidence: 92%

National Evaluation of HIV Service Resource Allocation in Tanzania

et al. 2023

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“…Implementing EUDC by providing psychoeducation and counseling may also have decreased symptoms in both intervention and control sites. Specific to this population, it is also possible that at the second follow-up (mean 11 months postpartum), women knew their infants’ HIV test results (which, while not testable in our study population, given the low rates of mother-to-child transmission in Dar es Salaam [ 38 ], were predominantly negative), which may have decreased stress and subsequently reduced depressive symptom severity in both groups. Particularly in resource-constrained settings, this evidence of a large reduction in depressive symptoms in the control group may suggest the need for better targeting of women with depression during the antenatal and early postpartum period when this intervention had the strongest effect.…”

Section: Discussionmentioning

confidence: 99%

A peer-facilitated psychological group intervention for perinatal women living with HIV and depression in Tanzania-Healthy Options: A cluster-randomized controlled trial

et al. 2022

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Background Perinatal women living with HIV (PWLH) have a greater risk of depression compared to other women; however, there are limited specialized mental health services available to them. We aimed to determine whether a stepped-care intervention facilitated by trained lay providers can improve mental health outcomes postpartum for PWLH. Methods and findings Healthy Options is a cluster-randomized controlled study conducted in 16 government-managed antenatal care clinics that provided HIV care for pregnant women in urban Tanzania. Recruitment occurred from May 2015 through April 2016, with the final round of data collection completed in October 2017. Participants included a consecutive sample of pregnant women under 30 weeks of gestation, living with HIV and depression, and attending the study clinics. Control sites received enhanced usual care for depression (EUDC). Intervention sites received EUDC plus the Healthy Options intervention, which includes prenatal group sessions of problem-solving therapy (PST) plus cognitive behavioral therapy (CBT) sessions for individuals showing depressive symptoms at 6 weeks postdelivery. We assessed depressive symptoms comparable to major depressive disorder (MDD) using the Patient Health Questionnaire-9 (PHQ-9) with a locally validated cutoff at 9 months and 6 weeks postpartum. The primary time point is 9 months postpartum. We examined differences in outcomes using an intent-to-treat analysis with a complete case approach, meaning those with data at the relevant time point were included in the analysis. We used generalized estimating equations accounting for clustering. Of 818 women screened using the PHQ-9, 742 were determined eligible and enrolled (395 intervention; 347 control); 649 women (87.5%) participated in the first follow-up and 641 women (86.4%) in the second. A majority (270, 74.6%) of women in the intervention arm attended 5 or more PST sessions. Women enrolled in Healthy Options demonstrated a 67% (RR 0.33; 95% CI: 0.22, 0.51; p-value: <0.001; corresponding to a 25.7% difference in absolute risk) lower likelihood of depressive symptoms than women in control clusters at 6 weeks postpartum. At 9 months postpartum, women enrolled in Healthy Options demonstrated a nonsignificant 26% (RR 0.74; 95% CI: 0.42, 1.3; p-value: 0.281; corresponding to a 3.2% difference in absolute risk) lower likelihood of depressive symptoms than women in control clusters. Study limitations include not using diagnostic interviews to measure depression and not blinding data collectors to intervention status during follow-up. Conclusions The Healthy Options intervention did not demonstrate reduction in depressive symptoms at 9 months postpartum, the primary outcome. Significant reductions were seen in depression symptoms at 6 weeks postpartum, the secondary outcome. Stepped-care interventions may be relevant for improving outcomes in the critical early postpartum window. Trial registration Clinical Trial registration number (closed to new participants) NCT02039973

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Health care costs associated with clinic visits for prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania

Abstract: Supplemental Digital Content is available in the text

Cited by 2 publications

References 32 publications

National Evaluation of HIV Service Resource Allocation in Tanzania

National Evaluation of HIV Service Resource Allocation in Tanzania

A peer-facilitated psychological group intervention for perinatal women living with HIV and depression in Tanzania-Healthy Options: A cluster-randomized controlled trial

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