Superior Outcomes and Lower Outpatient Costs With Scale-Up of Antiretroviral Therapy at the GHESKIO Clinic in Port-au-Prince, Haiti

Abstract

Background Treatment protocols and prices of antiretroviral therapy (ART) have changed over time. Yet limited data exist to evaluate the impact of these changes on patient outcomes and treatment costs in resource-poor settings. Methods We compared patient-level data on outcomes, utilization, and cost for the first two years of ART for a cohort of adult patients initiating ART in 2003–2004 and a cohort initiating ART in 2006–2008 at the GHESKIO clinic in Port-au-Prince, Haiti. Costs were measured from the health center perspective. Multivariate analyses were conducted to account for the potential impact of differences in disease severity at baseline. Results With the exclusion of patients who transferred care, 92% (167/181) of patients in the 2006–2008 cohort and 75% (150/200) in the 2003–2004 cohort were alive and in-care at the end of the study period. The mean cost per patient for the two-year study period was US$723 for the 2006–2008 cohort vs. US$1,191 for the 2003–2004 cohort, a cost difference of US$468 (p<0.0001). The mean cost per patient alive and in-care at the end of the two-year study period was US$744 for the 2006–2008 cohort vs. US$1,489 for the 2003–2004 cohort (p<0.0001). Conclusions HIV treatment outcomes in Haiti have improved over time while treatment costs declined by over 50% per patient alive and in-care at the end of the two-year study period. The major drivers in the reduction of treatment costs were the lower price of ART, lower costs for laboratory testing, and lower overhead costs.

The HIV Treatment Gap: Estimates of the Financial Resources Needed versus Available for Scale-Up of Antiretroviral Therapy in 97 Countries from 2015 to 2020

“…We estimated ranges for the unit cost per patient-year of facility-level overhead (e.g., for utilities) and personnel costs (e.g., for clinical health workers who directly deliver treatment interventions) based on a review of recent country-specific studies [ 28 , 53 – 55 , 57 , 58 , 60 – 63 ]. The estimates of unit costs of facility-level overhead differ across studies because of the inclusion of different cost elements.…”

“…We also excluded any multi-country regional support from PEPFAR or the Global Fund where the funding values could not be disaggregated by country. Support for ART for adults and children from PEPFAR extended to 39 countries and regional programs in fiscal year 2014 [ 55 ]. This support included ARV drugs and laboratory commodities for many of these countries, as well as health system strengthening and temporary staff.…”

“…For the 32 of our 97 countries that PEPFAR supports, PEPFAR resources for the cost categories included in our financial resource projections—ARVs, laboratory commodities, and facility-level overhead and personnel—were based on 2014 expenditure data from the interactive PEPFAR Dashboards database. This database includes planned budget and expenditure data from PEPFAR Country Operational Plans (see S4 Text ) [ 55 ]. We estimated two scenarios: expansive versus conservative PEPFAR contribution to facility-level personnel and overhead in each country.…”