Costs of streamlined HIV care delivery in rural Ugandan and Kenyan clinics in the SEARCH Studys
Costs of streamlined HIV care delivery in rural Ugandan and Kenyan clinics in the SEARCH Studys
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SEARCH 研究中乌干达和肯尼亚农村诊所简化艾滋病毒护理服务的成本
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
V. Jain
中科院分区：
文献类型：
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作者：
S. Shade;Thomas Osmand;Alex Luo;R. Aine;Elly Assurah;Betty Mwebaza;D. Mwai;A. Owaraganise;F. Mwangwa;J. Ayieko;D. Black;L. Brown;T. Clark;D. Kwarisiima;H. Thirumurthy;C. Cohen;E. Bukusi;E. Charlebois;L. Balzer;M. Kamya;M. Petersen;D. Havlir;V. Jain
目标/设计：随着抗逆转录病毒疗法在撒哈拉以南非洲使用新的有效护理模式迅速推广，缺乏关于这些方法成本的数据。我们在乌干达和肯尼亚的一项大型艾滋病毒检测和治疗研究中检查了简化的艾滋病毒护理提供模式的成本。研究方法：我们通过微成本计算技术、时间和运动研究、工作人员访谈和行政记录，计算了在17个健康设施中观察到的简化护理的每人每年（ppy）成本。成本类别包括工资、抗逆转录病毒疗法、病毒载量检测、经常性商品/服务和固定资本/设施成本。然后，我们在三种日益有效的规模扩大方案下对成本进行了建模：最低成本的ART，集中的病毒载量检测和政府医疗保健工作者的工资。我们评估了社区特定ART提供成本、护理保留率和病毒抑制之间的关系。结果：估计简化的艾滋病毒护理提供成本为291美元/ppy。ART（TDF/3 TC/EFV为117美元/ppy [40%]）和病毒载量检测（每年2次检测为110美元/ppy [39%]）相对于工资（51美元/ppy）、经常性成本（5美元/ppy）和固定成本（7美元/ppy）占主导地位。 优化的抗逆转录病毒疗法规模扩大，最低成本的抗逆转录病毒疗法（100美元/ppy），每年病毒载量测试（24美元/ppy），和政府医疗保健工资（27美元/ppy），降低精简的护理成本为163美元/ppy。我们发现，在保留和病毒抑制水平与精简的护理提供成本的诊所到诊所的异质性，但没有成本之间的相关性，无论是保留或病毒抑制。结论：在这项研究中，尽管包括病毒载量检测，但简化的艾滋病毒护理提供成本与先前的估计相似或更低;进一步优化可以进一步大幅降低成本。这些数据可以为扩大抗逆转录病毒疗法筹资的全球战略提供信息，以实现艾滋病规划署90-90-90的目标。
Objectives/design: As antiretroviral therapy (ART) rapidly expands in sub-Saharan Africa using new efficient care models, data on costs of these approaches are lacking. We examined costs of a streamlined HIV care delivery model within a large HIV test-and-treat study in Uganda and Kenya. Methods: We calculated observed per-person-per-year (ppy) costs of streamlined care in 17 health facilities in SEARCH Study intervention communities (NCT: 01864603) via micro-costing techniques, time-and-motion studies, staff interviews, and administrative records. Cost categories included salaries, ART, viral load testing, recurring goods/services, and fixed capital/facility costs. We then modeled costs under three increasingly efficient scale-up scenarios: lowest-cost ART, centralized viral load testing, and governmental healthcare worker salaries. We assessed the relationship between community-specific ART delivery costs, retention in care, and viral suppression. Results: Estimated streamlined HIV care delivery costs were $291/ppy. ART ($117/ppy for TDF/3TC/EFV [40%]) and viral load testing ($110/ppy for 2 tests/year [39%]) dominated costs versus salaries ($51/ppy), recurring costs ($5/ppy), and fixed costs ($7/ppy). Optimized ART scale-up with lowest-cost ART ($100/ppy), annual viral load testing ($24/ppy), and governmental healthcare salaries ($27/ppy), lowered streamlined care cost to $163/ppy. We found clinic-to-clinic heterogeneity in retention and viral suppression levels versus streamlined care delivery costs, but no correlation between cost and either retention or viral suppression. Conclusions: In the SEARCH Study, streamlined HIV care delivery costs were similar to or lower than prior estimates despite including viral load testing; further optimizations could substantially reduce costs further. These data can inform global strategies for financing ART expansion to achieve UNAIDS 90–90–90 targets.