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Costs of Streamlined HIV Care Delivery in Rural Ugandan and Kenyan Clinics in the SEARCH Study


Shade, Starley B.; Osmand, Thomas; Luo, Alex; Aine, Ronald; Assurah, Elly; Mwebaza, Betty; Mwai, Daniel N.; Owaraganise, Asiphas; Mwangwa, Florence; & Ayieko, James, et al. (2018). Costs of Streamlined HIV Care Delivery in Rural Ugandan and Kenyan Clinics in the SEARCH Study. AIDS, 32(15), 2179-2188. PMCID: PMC6143350


OBJECTIVES/DESIGN: As antiretroviral therapy (ART) rapidly expands in Sub-Saharan Africa using new efficient care models, data on costs of these approaches are lacking. We examined costs of a streamlined HIV care delivery model within a large HIV test-and-treat study in Uganda and Kenya.
METHODS: We calculated observed per-person-per-year (ppy) costs of streamlined care in 17 health facilities in SEARCH Study intervention communities (NCT:01864603) via micro-costing techniques, time-and-motion studies, staff interviews, and administrative records. Cost categories included salaries, ART, viral load (VL) testing, recurring goods/services, and fixed capital/facility costs. We then modeled costs under three increasingly efficient scale-up scenarios: (1) lowest-cost ART, (2) centralized VL testing, and (3) governmental healthcare worker salaries. We assessed the relationship between community-specific ART delivery costs, retention in care, and viral suppression.
RESULTS: Estimated streamlined HIV care delivery costs were $291/ppy. ART ($117/ppy for TDF/3TC/EFV [40%]) and VL testing ($110/ppy for 2 tests/year [39%]) dominated costs versus salaries ($51/ppy), recurring costs ($5/ppy), and fixed costs ($7/ppy). Optimized ART scale-up with lowest-cost ART ($100/ppy), annual VL testing ($24/ppy), and governmental healthcare salaries ($27/ppy), lowered streamlined care cost to $163/ppy. We found clinic-to-clinic heterogeneity in retention and viral suppression levels versus streamlined care delivery costs, but no correlation between cost and either retention or viral suppression.
CONCLUSIONS: In the SEARCH Study, streamlined HIV care delivery costs were similar to or lower than prior estimates despite including VL testing; further optimizations could substantially reduce costs further. These data can inform global strategies for financing ART expansion to achieve UNAIDS 90-90-90 targets.


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Journal Article

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Shade, Starley B.
Osmand, Thomas
Luo, Alex
Aine, Ronald
Assurah, Elly
Mwebaza, Betty
Mwai, Daniel N.
Owaraganise, Asiphas
Mwangwa, Florence
Ayieko, James
Black, Douglas
Brown, Lillian B.
Clark, Tamara D.
Kwarisiima, Dalsone
Thirumurthy, Harsha
Cohen, Craig R.
Bukusi, Elizabeth A.
Charlebois, Edwin D.
Balzer, Laura B.
Kamya, Moses R.
Petersen, Maya L.
Havlir, Diane V.
Jain, Vivek