Multi-Country analysis of treatment costs for HIV/AIDS (match): facility-level art unit cost analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia

Tagar, Elya, Sundaram, Maaya, Condliffe, Kate, Matatiyo, Blackson, Chimbwandira, Frank, Chilima, Ben, Mwanamanga, Robert, Moyo, Crispin, Chitah, Bona Mukosha, Nyemazi, Jean Pierre, Assefa, Yibeltal, Pillay, Yogan, Mayer, Sam, Shear, Lauren, Dain, Mary, Hurley, Raphael, Kumar, Ritu, McCarthy, Thomas, Batra, Parul, Gwinnell, Dan, Diamond, Samantha and Over, Mead (2014) Multi-Country analysis of treatment costs for HIV/AIDS (match): facility-level art unit cost analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia. PLoS One, 9 11: . doi:10.1371/journal.pone.0108304


Author Tagar, Elya
Sundaram, Maaya
Condliffe, Kate
Matatiyo, Blackson
Chimbwandira, Frank
Chilima, Ben
Mwanamanga, Robert
Moyo, Crispin
Chitah, Bona Mukosha
Nyemazi, Jean Pierre
Assefa, Yibeltal
Pillay, Yogan
Mayer, Sam
Shear, Lauren
Dain, Mary
Hurley, Raphael
Kumar, Ritu
McCarthy, Thomas
Batra, Parul
Gwinnell, Dan
Diamond, Samantha
Over, Mead
Title Multi-Country analysis of treatment costs for HIV/AIDS (match): facility-level art unit cost analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia
Journal name PLoS One   Check publisher's open access policy
ISSN 1932-6203
Publication date 2014-11-01
Sub-type Article (original research)
DOI 10.1371/journal.pone.0108304
Open Access Status DOI
Volume 9
Issue 11
Total pages 9
Place of publication San Francisco, CA, United States
Publisher Public Library of Science
Language eng
Formatted abstract
Background: Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia.

Methods and Findings: In 2010-2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2-8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77-95% alive and on treatment).

Conclusions: This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Public Health Publications
 
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