Cost of Differentiated HIV Antiretroviral Therapy Delivery Strategies in Sub-Saharan Africa: A Systematic Review
Cost of Differentiated HIV Antiretroviral Therapy Delivery Strategies in Sub-Saharan Africa: A Systematic Review
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DOI：
10.1097/qai.0000000000002195
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发表时间：
2019-12-01
影响因子：
3.6
通讯作者：
Barnabas, Ruanne V.
中科院分区：
文献类型：
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作者：
Roberts, D. Allen;Tan, Nicholas;Barnabas, Ruanne V.
背景：需要有效和可扩展的艾滋病毒治疗模式，以最大限度地利用现有资源取得健康成果。通过使服务适应客户需求，差异化抗逆转录病毒疗法（DART）有可能更有效地利用资源。我们进行了一项系统回顾，评估了撒哈拉以南非洲地区DART与护理标准的成本。方法：我们检索了PubMed、Embase、Global Health、EconLit和灰色文献，检索了2005年至2019年间发表的评估DART成本的研究。模型分为设施型和设施型。以社区为基础和以个人为基础vs以群体为基础。我们提取了2018年美元与标准护理相比，DART的年度每位患者服务交付成本和增量成本。结果：我们确定了12篇文章，报告了7个国家16种DART模型的成本。大多数模型是基于设施的（n = 12），位于乌干达（n = 7）。DART模型中每位患者的年费用（不包括药物）从27美元到889美元（2018年美元）不等。在报告增加成本的11种型号中，7种发现DART节省了成本。在成本节约模式中，每位患者每年的增量节省中位数为67美元。人员是降低成本最常见的驱动因素，但节省的费用有时会被较高的间接费用或利用率所抵消。结论：DART模型可以通过任务转移和减少就诊次数来节省人员成本。为了更好地理解DART的可扩展性，需要来自社区和群体模型的额外经济证据。为了降低成本，项目需要将DART模型与客户需求相匹配，而不会产生大量的开销。
Background: Efficient and scalable models for HIV treatment are needed to maximize health outcomes with available resources. By adapting services to client needs, differentiated antiretroviral therapy (DART) has the potential to use resources more efficiently. We conducted a systematic review assessing the cost of DART in sub-Saharan Africa compared with the standard of care.Methods: We searched PubMed, Embase, Global Health, EconLit, and the grey literature for studies published between 2005 and 2019 that assessed the cost of DART. Models were classified as facility-vs. community-based and individual- vs group-based. We extracted the annual per-patient service delivery cost and incremental cost of DART compared with standard of care in 2018 USD.Results: We identified 12 articles that reported costs for 16 DART models in 7 countries. The majority of models were facility-based (n = 12) and located in Uganda (n = 7). The annual cost per patient within DART models (excluding drugs) ranged from $27 to $889 (2018 USD). Of the 11 models reporting incremental costs, 7 found DART to be cost saving. The median incremental saving per patient per year among cost-saving models was $67. Personnel was the most common driver of reduced costs, but savings were sometimes offset by higher overheads or utilization.Conclusions: DART models can save personnel costs by task shifting and reducing visit frequency. Additional economic evidence from community-based and group models is needed to better understand the scalability of DART. To decrease costs, programs will need to match DART models to client needs without incurring substantial overheads.