Abstract
BackgroundTo date, little information exists on the costs of providing antiretroviral therapy (ART) within maternal and child health (MCH) clinics in Kenya. The main objective of this analysis was to estimate the annual incremental cost of providing ART within a MCH clinic for adult women initiated on ART during pregnancy over the first one and two years on treatment. The study site was the District Hospital in Kericho, Kenya.MethodsA micro-costing approach from the provider’s perspective, based on a retrospective review of patient medical records, was used to evaluate incremental costs of care (2012 USD). Cost per patient in two cohorts were evaluated: the MCH clinic group comprised of adult women who initiated ART at the site’s MCH clinic during pregnancy between 2008–2011; and for comparison, the ART clinic group comprised of adult, non-pregnant women who initiated ART at the site’s ART clinic during 2008–2011. The two groups were matched on age and baseline CD4 count at initiation. Retention at year one/two on ART was defined as having completed a clinic visit at 365/730 days on ART +/- 90 days.ResultsFor patients defined as retained in care at year one, average incremental costs per patient were $234 for the MCH clinic group (median: 215; IQR: 186, 282) and $292 in the ART clinic group (median: 227; IQR: 178, 357). ARV and laboratory costs were less on average for the MCH clinic group compared to the ART clinic group (due to lower cost regimens and fewer tests), while personnel costs were higher for the MCH clinic group.ConclusionsThe annual incremental cost per patient of providing ART were similar in the two clinic settings in 2012. With shifts in recommended ARV regimens and lab monitoring over time, annual costs of care (using 2016 USD unit costs) have remained relatively constant in nominal terms for the MCH clinic group but have fallen substantially for the ART clinic group (from nominal $292 in 2012 to nominal $227 in 2016).
Highlights
Kenya remains a country with a substantial burden of disease from HIV
For patients defined as retained in care at year one, average incremental costs per patient were $234 for the maternal and child health (MCH) clinic group and $292 in the antiretroviral therapy (ART) clinic group
ARV and laboratory costs were less on average for the MCH clinic group compared to the ART clinic group, while personnel costs were higher for the MCH clinic group
Summary
Kenya remains a country with a substantial burden of disease from HIV. In 2015, an estimated 1.5 million Kenyans were living with HIV (5.5% of men and 6.3% of women), with 77,000 new infections and 35,000 deaths from AIDS.[1]. Kenyan guidelines for the use of antiretroviral therapy (ART) for pregnant and postpartum women, as part of the overall package of prevention-of-mother-to-child-transmission of HIV/ AIDS (PMTCT), have evolved substantially over the past decade. Little information exists on the costs of providing antiretroviral therapy (ART) within maternal and child health (MCH) clinics in Kenya. The main objective of this analysis was to estimate the annual incremental cost of providing ART within a MCH clinic for adult women initiated on ART during pregnancy over the first one and two years on treatment. The study site was the District Hospital in Kericho, Kenya
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