Abstract
IntroductionAfter almost 10 years of PEPFAR funding for antiretroviral therapy (ART) treatment programmes in Kenya, little is known about the cost of care provided to HIV-positive patients receiving ART. With some 430,000 ART patients, understanding and managing costs is essential to treatment programme sustainability.MethodsUsing patient-level data from medical records (n=120/site), we estimated the cost of providing ART at three treatment sites in the Rift Valley Province of Kenya (a clinic at a government hospital, a hospital run by a large agricultural company and a mission hospital). Costs included ARV and non-ARV drugs, laboratory tests, salaries to personnel providing patient care, and infrastructure and other fixed costs. We report the average cost per patient during the first 12 months after ART initiation, stratified by site, and the average cost per patient achieving the primary outcome, retention in care 12 months after treatment initiation.ResultsThe cost per patient initiated on ART was $206, $252 and $213 at Sites 1, 2 and 3, respectively. The proportion of patients remaining in care at 12 months was similar across all sites (0.82, 0.80 and 0.84). Average costs for the subset of patients who remained in care at 12 months was also similar (Site 1, $229; Site 2, $287; Site 3, $237). Patients not retained in care cost substantially less (Site 1, $104; Site 2, $113; Site 3, $88). For the subset of patients who remained in care at 12 months, ART medications accounted for 51%, 44% and 50% of the costs, with the remaining costs split between non-ART medications (15%, 11%, 10%), laboratory tests (14%, 15%, 15%), salaries to personnel providing patient care (9%, 11%, 12%) and fixed costs (11%, 18%, 13%).ConclusionsAt all three sites, 12-month retention in care compared favourably to retention rates reported in the literature from other low-income African countries. The cost of providing treatment was very low, averaging $224 in the first year, less than $20/month. The cost of antiretroviral medications, roughly $120 per year, accounted for approximately half of the total costs per patient retained in care after 12 months.
Highlights
After almost 10 years of President’s Emergency Plan for AIDS Relief (PEPFAR) funding for antiretroviral therapy (ART) treatment programmes in Kenya, little is known about the cost of care provided to HIV-positive patients receiving ART
Study sites and sample selection The study was conducted in Kenya, where approximately 430,000 people were on ART at the end of 2010 [15]
Resource utilization and primary outcome For each study subject, we reviewed patient medical records to determine quantities of ARV medications, non-ARV drugs, laboratory tests, and clinic visits utilized by each patient in the 12 months following ART initiation
Summary
After almost 10 years of PEPFAR funding for antiretroviral therapy (ART) treatment programmes in Kenya, little is known about the cost of care provided to HIV-positive patients receiving ART. Almost 10 years after public sector provision of antiretroviral therapy (ART) began in many African countries, better information on the costs to healthcare providers for delivering medical care to patients on ART is still needed. Such costs obviously include the cost of antiretroviral medications and the cost of laboratory tests, non-ART medications, medical staff providing care and fixed costs at the site. In one of the earliest studies in South Africa in 2007, the average cost per patient treated at a large public sector clinic during the first year on ART was $756 [5]. Despite the fact that Kenya has been one of the largest recipients of funds from the US President’s Emergency Plan for AIDS Relief (PEPFAR), second only to South Africa in funding received, as well as a major recipient of support from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), a recent literature review of ART cost studies did not find a single published estimate for Kenya [12Á14]
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