Assessing the cost of providing a prevention of mother-to-child transmission of HIV/AIDS service in Ethiopia: urban-rural health facilities setting
Assessing the cost of providing a prevention of mother-to-child transmission of HIV/AIDS service in Ethiopia: urban-rural health facilities setting
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DOI：
10.1186/s12913-019-3978-4
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发表时间：
2019-03-06
影响因子：
2.8
通讯作者：
Johns, Benjamin
中科院分区：
文献类型：
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作者：
Zegeye, Elias Asfaw;Mbonigaba, Josue;Johns, Benjamin
背景虽然当地环境成本计算证据与医疗保健规划、预算和成本效益分析相关，但在埃塞俄比亚仍然很少。本研究评估了在不同流行率（高、低）和社会经济（城市、农村）背景下提供预防艾滋病毒/艾滋病母婴传播 (PMTCT) 服务的成本。方法从最新的 2012 年产前哨点艾滋病毒流行率报告中特意选择了埃塞俄比亚六个地区的 12 个卫生机构。选择了城市地区艾滋病毒感染率最高（8.1%至17.3%）的六家卫生机构和农村地区艾滋病毒感染率最低（0.0%至0.1%）的六家卫生机构。采用微观成本计算方法来识别、衡量和评估用于提供综合预防母婴传播服务的资源。该分析针对不同的 PMTCT 服务包进行。我们还估算了城市和农村地区的国家成本。结果在城市艾滋病毒高流行医疗机构中，每对孕妇-婴儿每年 (PPY) 的平均成本为 ETB 6280（319 美元）至 ETB 21,620（1099 美元）。在农村艾滋病毒感染率低的卫生机构，费用从 4323 ETB（220 美元）到 7539 ETB（383 美元）不等。城市卫生机构提供预防母婴传播服务的费用是农村卫生机构费用的两倍多。由于投入成本较高且可能效率低下（尽管访问次数较多），城市环境中每个 PPY 的平均成本是农村环境中成本的两倍多。消耗品（包括抗逆转录病毒药物）和基础设施是城市和农村卫生机构的主要成本驱动因素。在预防母婴传播服务组成部分中，抗逆转录病毒治疗方案B+随访和咨询所占费用比例最高，为58%至72%。在全国范围内，按照目前的覆盖范围，城市和农村地区 PMTCT 服务的成本分别为 600 万美元和 300 万美元。结论分析表明，用于 PMTCT 服务包的资源因卫生设施和艾滋病毒流行情况而异。在艾滋病毒高流行城市卫生机构提供预防母婴传播服务的费用高于农村机构。针对具体情况的成本计算对于为卫生服务管理和优先事项设定提供当地敏感的证据至关重要。
BackgroundWhile local context costing evidence is relevant for healthcare planning, budgeting and cost-effectiveness analysis, it continues to be scarce in Ethiopia. This study assesses the cost of providing a prevention of mother-to-child transmission of HIV/AIDS (PMTCT) service across heterogeneous prevalence (high, low) and socio-economic (urban, rural) contexts.MethodsA total of 12 health facilities from six regions in Ethiopia were purposively selected from the latest 2012 antenatal sentinel HIV prevalence report. Six health facilities with the highest HIV prevalence (8.1 to 17.3%) in urban settings and six health facilities with the lowest prevalence (0.0 to 0.1%) in rural settings were selected. A micro-costing approach was applied to identify, measure and value resources used for the provision of a comprehensive PMTCT service. The analysis was conducted across different PMTCT service packages. We also estimated national costs in urban and rural contexts.ResultsThe average cost per pregnant woman-infant pair per year (PPY) ranged from ETB 6280 (USD 319) to ETB 21,620 (USD 1099) in the urban high HIV prevalence health facilities setting. In rural low HIV prevalence health facilities, the cost ranged from ETB 4323 (USD 220) to ETB 7539 (USD 383).PMTCT service provision in urban health facilities costs more than twice the cost in rural health facilities. The average cost per PPY in an urban setting was more than double the cost in a rural setting due to the higher cost of inputs and possible inefficiencies (although there were a higher number of visits). Consumables (including antiretroviral drugs) and infrastructure were the major cost drivers in both the urban and rural health facilities. Among PMTCT service components, anti-retroviral treatment Option B+ follow-up and counselling accounted for the highest proportion of costs, which ranged from 58 to 72%. Nationally, at the current coverage, the cost of PMTCT service was USD 6 million and USD 3 million in urban and rural settings, respectively.ConclusionsThe analysis suggests that resources used for PMTCT service packages varied across health facilities and HIV prevalence contexts. Providing PMTCT service in the high HIV prevalence urban health facilities costs more than in the rural facilities. Context-specific costing was vital to provide locally sensitive evidence for health service management and priority setting.