دورية أكاديمية
Similar costs and outcomes for differentiated service delivery models for HIV treatment in Uganda.
| العنوان: | Similar costs and outcomes for differentiated service delivery models for HIV treatment in Uganda. |
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| المؤلفون: | Guthrie T; Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. guthriehealthfinancingconsult@gmail.com., Muheki C; Health Net Consult, Kampala, Uganda., Rosen S; Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.; Department of Global Health, School of Public Health, Boston University, Boston, MA, United States of America., Kanoowe S; Health Net Consult, Kampala, Uganda., Lagony S; Health Net Consult, Kampala, Uganda., Greener R; Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Miot J; Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Balidawa H; Ministry of Health, Kampala, Uganda., Kiggundu J; Ministry of Health, Kampala, Uganda., Calnan J; USAID, Kampala, Uganda., Dejene S; USAID, Kampala, Uganda., Xulu T; Right To Care, EQUIP, North Centurion, South Africa., Sigwebela N; Right To Care, EQUIP, North Centurion, South Africa., Long LC; Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.; Department of Global Health, School of Public Health, Boston University, Boston, MA, United States of America. |
| المصدر: | BMC health services research [BMC Health Serv Res] 2022 Nov 03; Vol. 22 (1), pp. 1315. Date of Electronic Publication: 2022 Nov 03. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: London : BioMed Central, [2001- |
| مواضيع طبية MeSH: | HIV Infections*/drug therapy , Anti-HIV Agents*/therapeutic use, Adult ; Humans ; Adolescent ; Uganda ; Retrospective Studies ; Government Programs |
| مستخلص: | This cost-outcome study estimated, from the perspective of the service provider, the total annual cost per client on antiretroviral therapy (ART) and total annual cost per client virally suppressed (defined as < 1000 copies/ml at the time of the study) in Uganda in five ART differentiated service delivery models (DSDMs). These included both facility- and community-based models and the standard of care (SOC), known as the facility-based individual management (FBIM) model. The Ministry of Health (MOH) adopted guidelines for DSDMs in 2017 and sought to measure their costs and outcomes, in order to effectively plan for their resourcing, implementation, and scale-up. In Uganda, the standard of care (FBIM) is considered as a DSDM option for clients requiring specialized treatment and support, or for those who select not to join an alternative DSDM. Note that clients on second-line regimes and considered as "established on treatment" can join a suitable DSDM.Using retrospective client record review of a cohort of clients over a two-year period, with bottom-up collection of clients' resource utilization data, top-down collection of above-delivery level and delivery-level providers' fixed operational costs, and local unit costs. Forty-seven DSDMs located at facilities or community-based points in the four regions of Uganda were included in the study, with 653 adults on ART (> 18 years old) enrolled in a DSDM. The study found that retention in care was 98% for the sample as a whole [96-100%], and viral suppression, 91% [86-93%]. The mean cost to the provider (MOH or NGO implementers) was $152 per annum per client treated, ranging from $141 to $166. Differences among the models' costs were largely due to clients' ARV regimens and the proportions of clients on second line regimens. Service delivery costs, excluding ARVs, other medicines and laboratory tests, were modest, ranging from $9.66-16.43 per client per year. We conclude that differentiated ART service delivery in Uganda achieved excellent treatment outcomes at a cost similar to the standard of care. While large budgetary savings might not be immediately realized, the reallocation of "saved" staff time could improve health system efficiency and with their equivalent or better outcomes and large benefits to clients, client-centred differentiated models would nevertheless add great societal value. (© 2022. The Author(s).) |
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| معلومات مُعتمدة: | AID-OAA-A-15-00070 United States Agency for International Development; AID-OAA-A-15-00070 United States Agency for International Development; AID-OAA-A-15-00070 United States Agency for International Development; AID-OAA-A-15-00070 United States Agency for International Development; AID-OAA-A-15-00070 United States Agency for International Development; AID-OAA-A-15-00070 United States Agency for International Development; AID-OAA-A-15-00070 United States Agency for International Development; AID-OAA-A-15-00070 United States Agency for International Development; AID-OAA-A-15-00070 United States Agency for International Development; AID-OAA-A-15-00070 United States Agency for International Development; AID-OAA-A-15-00070 United States Agency for International Development; AID-OAA-A-15-00070 United States Agency for International Development |
| فهرسة مساهمة: | Keywords: Cost; Differentiated service delivery; Economic evaluation; HIV; Health outcomes; Uganda |
| المشرفين على المادة: | 0 (Anti-HIV Agents) |
| تواريخ الأحداث: | Date Created: 20221104 Date Completed: 20221107 Latest Revision: 20221108 |
| رمز التحديث: | 20221213 |
| مُعرف محوري في PubMed: | PMC9635081 |
| DOI: | 10.1186/s12913-022-08629-4 |
| PMID: | 36329450 |
| قاعدة البيانات: | MEDLINE |
Find this article in full text from Springer Verlag. 
Full Text Finder | تدمد: | 1472-6963 |
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| DOI: | 10.1186/s12913-022-08629-4 |