Economic evaluation of integrated services for non-communicable diseases and HIV: costs and client outcomes in rural Malawi.
Economic evaluation of integrated services for non-communicable diseases and HIV: costs and client outcomes in rural Malawi.
复制标题
DOI：
10.1136/bmjopen-2022-063701
复制
发表时间：
2022-11-28
期刊：
影响因子：
2.9
通讯作者：
中科院分区：
文献类型：
--
作者：
评估在东南部非洲农村和偏远地区将非传染性疾病筛查和治疗纳入艾滋病毒服务的成本和服务结果。前瞻性队列研究。马拉维Neno区的初级和二级卫生设施。2016年7月至2017年6月期间，综合慢性护理诊所(IC3)的新成人登记人数。我们从卫生系统的角度使用基于活动的成本计算方法，量化了综合慢性护理的年化总成本和人均经济成本(2017美元)。我们还测量了同一时期的注册人数、留校率和死亡率。此外，我们还测量了HIV(病毒载量)、高血压(控制血压)、糖尿病(平均血糖)、哮喘(哮喘严重程度)和癫痫(癫痫发作频率)的临床结果。提供艾滋病毒和非传染性疾病综合护理的年度总费用为2 461 901美元，为9 471名参保者提供护理，或人均260美元。相比之下，6,541人接受的独立艾滋病毒服务为2 138 907，或人均327美元。在12个月的时间里，有1970名新客户加入了IC3，保留率为80%。在艾滋病毒携带者中，81%的患者在注册的第一年内获得了无法检测到的病毒载量。有高血压、哮喘和癫痫的患者的临床结果有显著改善(P<；0.05)，但糖尿病患者没有显著改善(P>；0.05)。IC3是完全整合艾滋病毒和非传染性疾病护理的最大例子之一。将慢性健康状况的筛查和治疗纳入马拉维的艾滋病毒平台似乎是一种财务上可行的办法，与几项积极的临床结果有关。
To evaluate the costs and client outcomes associated with integrating screening and treatment for non-communicable diseases (NCDs) into HIV services in a rural and remote part in southeastern Africa. Prospective cohort study. Primary and secondary level health facilities in Neno District, Malawi. New adult enrollees in Integrated Chronic Care Clinics (IC3) between July 2016 and June 2017. We quantified the annualised total and per capita economic cost (US$2017) of integrated chronic care, using activity-based costing from a health system perspective. We also measured enrolment, retention and mortality over the same period. Furthermore, we measured clinical outcomes for HIV (viral load), hypertension (controlled blood pressure), diabetes (average blood glucose), asthma (asthma severity) and epilepsy (seizure frequency). The annualised total cost of providing integrated HIV and NCD care was $2 461 901 to provide care to 9471 enrollees, or $260 per capita. This compared with $2 138 907 for standalone HIV services received by 6541 individuals, or $327 per capita. Over the 12-month period, 1970 new clients were enrolled in IC3, with a retention rate of 80%. Among clients with HIV, 81% achieved an undetectable viral load within their first year of enrolment. Significant improvements were observed among clinical outcomes for clients enrolled with hypertension, asthma and epilepsy (p<0.05, in all instances), but not for diabetes (p>0.05). IC3 is one of the largest examples of fully integrated HIV and NCD care. Integrating screening and treatment for chronic health conditions into Malawi’s HIV platform appears to be a financially feasible approach associated with several positive clinical outcomes.
登录
查看更多内容
DOI：
10.15585/mmwr.mm7021a2
发表时间：
2021-05-28
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Lecher SL;Fonjungo P;Ellenberger D;Toure CA;Alemnji G;Bowen N;Basiye F;Beukes A;Carmona S;de Klerk M;Diallo K;Dziuban E;Kiyaga C;Mbah H;Mengistu J;Mots'oane T;Mwangi C;Mwangi JW;Mwasekaga M;N'tale J;Naluguza M;Ssewanyana I;Stevens W;Zungu I;Bhairavabhotla R;Chun H;Gaffga N;Jadczak S;Lloyd S;Nguyen S;Pati R;Sleeman K;Zeh C;Zhang G;Alexander H
通讯作者：
Alexander H
DOI：
10.1097/qai.0000000000000261
发表时间：
2014-09-01
影响因子：
3.6
作者：
Crabtree-Ramirez, Brenda;Del Rio, Carlos;Sierra-Madero, Juan
通讯作者：
Sierra-Madero, Juan
DOI：
10.1016/j.hjdsi.2015.09.006
发表时间：
2015-12-01
影响因子：
2.5
作者：
Gupta, Neil;Bukhman, Gene
通讯作者：
Bukhman, Gene
DOI：
10.1080/09540121.2017.1344350
发表时间：
2018-01-01
影响因子：
1.7
作者：
Haldane, Victoria;Legido-Quigley, Helena;Perel, Pablo
通讯作者：
Perel, Pablo
影响因子：
6
作者：
Alhaj, Mohammad;Amberbir, Alemayehu;van Oosterhout, Joep J.
通讯作者：
van Oosterhout, Joep J.