Adherence clubs for long-term provision of antiretroviral therapy: cost-effectiveness and access analysis from Khayelitsha, South Africa
Adherence clubs for long-term provision of antiretroviral therapy: cost-effectiveness and access analysis from Khayelitsha, South Africa
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DOI：
10.1111/tmi.12736
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发表时间：
2016-09-01
影响因子：
3.3
通讯作者：
Cleary, Susan
中科院分区：
文献类型：
--
作者：
Bango, Funeka;Ashmore, John;Cleary, Susan
由于南非艾滋病毒流行的规模要求创新的护理模式，改善患者的可及性，同时克服长期的人力资源短缺，我们（i）评估非专业卫生工作者领导的团体坚持俱乐部的成本效益，与护士驱动的“护理标准”相比，（ii）描述和评估相关的患者成本和可及性差异。在南非Khayelitsha的一个忙碌繁忙的初级卫生保健环境中，有效性分析比较了“坚持俱乐部”创新与传统护士驱动的护理。在每一种替代方案中，我们计算提供者成本，并估计护理保留率和病毒抑制率，作为计划有效性的关键指标。所有结果均按年度或每患者年列出。在相同的设置，一个较小的样本的患者进行了采访，以了解直接和间接的非医疗保健成本和访问的影响的替代品。使用McIntyre及其同事2009年的框架测量了访问。结果坚持俱乐部是更具成本效益的护理模式，每患者年的成本为300美元与374美元，1年的护理保留率为98.03%（95% CI 97.67-98.33），标准治疗为95.49%（95% CI 95.01-95.94）。俱乐部的病毒抑制率为99.06%（95% CI 98.82-99.27），标准治疗为97.20%（95% CI 96.81-97.56）。接受采访时，俱乐部的病人报告少错过访问，更短的等待时间和更高的可接受性的服务相比standard of care.CONCLUSIONS坚持俱乐部提供的潜力，以提高医疗效率和患者的可及性。应支持扩大其规模。
OBJECTIVES As the scale of the South African HIV epidemic calls for innovative models of care that improve accessibility for patients while overcoming chronic human resource shortages, we (i) assess the cost-effectiveness of lay health worker-led group adherence clubs, in comparison with a nurse-driven 'standard of care' and (ii) describe and evaluate the associated patient cost and accessibility differences.METHODS Our cost-effectiveness analysis compares an 'adherence club' innovation to conventional nurse-driven care within a busy primary healthcare setting in Khayelitsha, South Africa. In each alternative, we calculate provider costs and estimate rates of retention in care and viral suppression as key measures of programme effectiveness. All results are presented on an annual or per patient-year basis. In the same setting, a smaller sample of patients was interviewed to understand the direct and indirect non-healthcare cost and access implications of the alternatives. Access was measured using McIntyre and colleagues' 2009 framework.RESULTS Adherence clubs were the more cost-effective model of care, with a cost per patient-year of $300 vs. $374 and retention in care at 1 year of 98.03% (95% CI 97.67-98.33) for clubs vs. 95.49% (95% CI 95.01-95.94) for standard of care. Viral suppression in clubs was 99.06% (95% CI 98.82-99.27) for clubs vs. 97.20% (95% CI 96.81-97.56) for standard of care. When interviewed, club patients reported fewer missed visits, shorter waiting times and higher acceptability of services compared to standard of care.CONCLUSIONS Adherence clubs offer the potential to enhance healthcare efficiency and patient accessibility. Their scale-up should be supported.