Abstract
IntroductionIn response to the increasing burden of HIV, the Ugandan government has employed different service delivery models since 2004 that aim to reduce costs and remove barriers to accessing HIV care. These models include community-based approaches to delivering antiretroviral therapy (ART) and delegating tasks to lower-level health workers. This study aimed to provide data on annual ART cost per client among three different service delivery models in Uganda.MethodsCosting data for the entire year 2012 were retrospectively collected as part of a larger task-shifting study conducted in three organizations in Uganda: Kitovu Mobile (KM), the AIDS Support Organisation (TASO) and Uganda Cares (UC). A standard cost data capture tool was developed and used to retrospectively collect cost information regarding antiretroviral (ARV) drugs and non-ARV drugs, ART-related lab tests, personnel and administrative costs. A random sample of four TASO centres (out of 11), four UC clinics (out of 29) and all KM outreach units were selected for the study.ResultsCost varied across sites within each organization as well as across the three organizations. In addition, the number of annual ART visits was more frequent in rural areas and through KM (the community distribution model), which played a major part in the overall annual ART cost. The annual cost per client (in USD) was $404 for KM, $332 for TASO and $257 for UC. These estimates were lower than previous analyses in Uganda or the region compared to data from 2001 to 2009, but comparable with recent estimates using data from 2010 to 2013. ARVs accounted for the majority of the total cost, followed by personnel and operational costs.ConclusionsThe study provides updated data on annual cost per ART visit for three service delivery models in Uganda. These data will be vital for in-country budgetary efforts to ensure that universal access to ART, as called for in the 2015 World Health Organization (WHO) guidelines, is achievable. The lower annual ART cost found in this study indicates that we may be able to treat all people with HIV as laid out in the 2015 WHO guidelines. The variation of costs across sites and the three models indicates the potential for efficiency gains.
Highlights
In response to the increasing burden of HIV, the Ugandan government has employed different service delivery models since 2004 that aim to reduce costs and remove barriers to accessing HIV care
The available costing studies have had a broader focus on public sector health facilities or were solely based on budgeting data, without necessarily providing actual costing data [11]. To help fill this gap, we aimed to provide the descriptive annual antiretroviral therapy (ART) cost per ART client at the three largest non-profit organizations serving people living with HIV (PLHIV) in Uganda Á The AIDS Support Organization (TASO), Kitovu Mobile (KM) and Uganda Cares (UC) Á using a retrospective review of routine data
Clients at KM made an average of nine visits to the KM outreach locations for ART care, whereas the AIDS Support Organisation (TASO) clients averaged five visits and UC clients averaged seven visits annually
Summary
In response to the increasing burden of HIV, the Ugandan government has employed different service delivery models since 2004 that aim to reduce costs and remove barriers to accessing HIV care. These data will be vital for in-country budgetary efforts to ensure that universal access to ART, as called for in the 2015 World Health Organization (WHO) guidelines, is achievable. The World Health Organization (WHO) has recently recommended HIV treatment to all PLHIV regardless of their CD4 count, and many countries are planning on adopting this recommendation [3] All of these factors are contributing to an increased demand on human and financial resources to deliver ART, careful planning and budgeting are needed to ensure universal access to ART [4,5]
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