Provider‐ and patient‐level costs associated with providing antiretroviral therapy during the postpartum phase to women living with HIV in South Africa: A cost comparison of three postpartum models of care

Abstract

objective To compare the unit and total costs of three models of ART care for mother-infant pairs during the postpartum phase from provider and patient's perspectives: (i) local standard of care with women in general ART services and infants at well-baby clinics; (ii) women and infants continue to receive care through an integrated maternal and child care approach during the postpartum breastfeeding period; and (iii) referral of women directly to community adherence clubs with their infants receiving care at well-baby clinics. methods Capital and recurrent cost data (relating to buildings, furniture, equipment, personnel, overheads, maintenance, medication, diagnostic tests and immunisations) were collected from a provider's perspective at six sites in Cape Town, South Africa. Patient time, collected via time-andmotion observation and questionnaires, was used to estimate patient perspective costs and is comprised of lost productivity time, time spent travelling and the direct cost of travelling.

Why do Integrated Maternal HIV and Infant Healthcare Services work? A Secondary Analysis of a Randomised Controlled Trial in South Africa

“…We hypothesise that the intervention may be effective through a range of mechanisms that may operate differently within different groups of women, and should be explored in a larger trial. For example, integrated MCH services reduce the economic burden of attending separate visits and may thus be of most benefit to women experiencing higher levels of poverty [ 73 ]. In addition, we hypothesise that receiving HIV care concurrently with infant health care within the MCH clinic may lead to less inadvertent disclosure than attending a separate adult HIV clinic, and thus may be most beneficial to women who experience the highest levels of stigma [ 12 ].…”

“…Although these measures were originally developed several decades ago in high-income countries, the constructs assessed and items included in these scales are still relevant and applicable to multiple settings. Although we attempted to collect patient-level data on direct and indirect costs to measure the economic burden of attending clinic visits, these data were only available for a subset of participants and it was not possible to accurately quantify costs at the individual level [ 73 ]. In addition, true modifiers and mediators of the intervention effect may not have been measured as part of the trial.…”

Cost‐effectiveness of broadly neutralizing antibody prophylaxis for HIV‐exposed infants in sub‐Saharan African settings

“…Country‐specific HIV prevalence and maternal and infant HIV care cascade characteristics were informed by UNAIDS estimates, Demographic and Health Surveys, Multiple Indicator Cluster Surveys and published literature (Table 1 and Table A5) [1, 6–8, 10, 12, 19–64]. The three settings evaluated in this analysis were chosen to reflect a range of maternal awareness of chronic HIV infection (Côte d'Ivoire: 92%, South Africa: 99% and Zimbabwe: 98%) [1, 26, 35, 36, 53], ART uptake in pregnancy (Côte d'Ivoire: 87%, South Africa: 98% and Zimbabwe: 93%) [1], mean breastfeeding duration (Côte d'Ivoire: 14 months, South Africa: 6 months and Zimbabwe: 13 months) [35, 36, 51, 56] and 2019 GDP per capita (Côte d'Ivoire: $2276, South Africa: $6001 and Zimbabwe: $1464) [65].…”

Cost-effectiveness of broadly neutralizing antibodies for infant HIV prophylaxis in settings with high HIV burdens: a simulation modeling study

“…The base case average cost for a 3-bNAb combination was modeled as $20 per dose, including the estimated production costs ($11, assuming a 100mg bNAb dose), as well as routine delivery (including training, personal protective equipment, cold-chain, and social mobilization, $2), personnel ($1), and facility/overhead ($3) costs based on an analysis of vaccine delivery costing data from 92 countries, conservatively rounded up to the nearest $10 (Supplementary Methods). 26–29 We also applied a cost of identifying high-risk infants in the HR-HIVE strategies by adding the cost of a maternal quantitative viral load test, associated clinic visit (including personnel and overhead costs), and result return with counseling ($31·66) per infant known to be HIV-exposed but in a secondary analysis also examined the cost-effectiveness of HR-HIVE strategies when withholding this cost (Supplementary Table 2). All costs are reported in 2020 USD.…”