Costs of Providing Care for HIV-Infected Adults in an Urban HIV Clinic in Soweto, South Africa

Johns Hopkins University Center for Tuberculosis Research, Baltimore, MD, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 03/2009; 50(3):327-30. DOI: 10.1097/QAI.0b013e3181958546
Source: PubMed


As access to antiretroviral therapy (ART) in sub-Saharan Africa expands, estimates of the costs of initiating and maintaining patients on ART are important to program planning, budgeting, and cost-effectiveness analyses.
Total costs of providing HIV care, including ART, in an urban, nongovernmental, adult clinic in Soweto, South Africa, were estimated from October 2004 through March 2005. Personnel costs were estimated using individuals' work time and salary, and for across-organization services (eg, information technology), a proportion of entire annual costs was applied. Utilization of medications, laboratories, and radiographic tests were estimated by a random sample of patient charts (10%) and applied to the entire cohort.
Nine hundred sixty-six adult patients received care during the study period (75% female, median age 34 years, median CD4 count at ART initiation: 109 cells/mm). Seventeen percent were stable on ART at entry, 61% initiated ART, and 22% did not receive ART over the course of the study. Mean cost of the entire program (in US $) was $92,388 per month, and mean per patient cost of care-regardless of ART treatment status-was $98.1 per month. Among adults on ART, costs were lowest for those already on ART ($119.0/month) and highest for those initiating ART ($209.7/month) in the first month and $130.0 the following month. Human resources and antiretrovirals each accounted for one third of overall costs.
The monthly cost of treating HIV-infected patients in an urban South African clinic was highest in the month of initiation and lower for stable patients, with costs driven predominantly by antiretrovirals and personnel.

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Available from: James Mcintyre, Oct 13, 2015
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    • "Although the actual costs of ARV medicine, outpatient and inpatient care may be higher or lower than other centers due to differences in health care systems across and inside any country, the proportional differences we identified are remarkably similar to those reported by others in costing studies, and, thus, the analysis and discussion should be widely applicable. Our study also only reports on costs in a developed country and as such is not directly relevant to costing studies in developing nations where clinical, demographic, and economic issues are significantly different [51–54], at least to a degree. The underlying aspects and costing principles presented in our study can be applied to other situations albeit with differing cost estimates. "
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    ABSTRACT: We describe the immediate- and longer-term direct medical costs of care for individuals diagnosed with HIV at CD4 counts <350/mm(3) ("late presenters"). We collected and stratified by initial CD4 count all inpatient, outpatient, and drug costs for all newly diagnosed patients accessing HIV care within Southern Alberta from 1/1/1995 to 1/1/2010. 59% of new patients were late presenters. We found significantly higher costs for late presenters, especially inpatient costs, during the first year after accessing care. Direct medical costs remained almost twice as high for late presenters in subsequent years compared to patients presenting with CD4 counts >350/mm(3) despite significantly their improved CD4 counts. The sustained high cost for late presenters has implications for recent recommendations for wider routine HIV testing and the earlier initiation of cART. Earlier diagnosis and treatment, while increasing the immediate expenditures within a population, may produce both direct and indirect cost savings in the longer term.
    AIDS research and treatment 01/2012; 2012(4840):757135. DOI:10.1155/2012/757135
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    • "These findings add to the small evidence base on economic costs of resources used to produce HIV ⁄ AIDS services and the components of these costs. Consistent with other studies (Hounton et al. 2008; Rosen et al. 2008; Martinson et al. 2009), we found total costs of services to be dominated by the costs of drugs, laboratory tests and clinical labour. For each visit type, variability in average unit costs and cost components across facilities suggests that some potential may exist to reduce costs through harmonization of care protocols and also by using fixed resources more intensively, particularly at PMTCT service points and laboratories. "
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    Tropical Medicine & International Health 10/2010; 16(1):110-8. DOI:10.1111/j.1365-3156.2010.02640.x · 2.33 Impact Factor
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    ABSTRACT: We assessed risk factors for viremia and drug resistance among long-term recipients of antiretroviral therapy (ART) in South Africa. In 2008, we conducted a cross-sectional study among patients receiving ART for 12 months or more. Genotypic resistance testing was performed on individuals with a viral load higher than 400 RNA copies/ml. Multiple logistic regression analysis was used to assess associations. Of 998 participants, 75% were women with a median age of 41 years. Most (64%) had been on treatment for more than 3 years. The prevalence of viremia was 14% (n = 139): 12% (102/883) on first-line [i.e. nonnucleoside reverse-transcriptase inhibitor (NNRTI)-based regimen] and 33% (37/115) on second-line (i.e. protease inhibitor (PI)-based regimen) ART. Of viremic patients, 78% had drug resistance mutations. For NRTIs, NNRTIs and PIs, the prevalence of mutations was 64, 81 and 2%, respectively, among first-line failures and 29, 54 and 6%, respectively, among second-line failures. M184V/I, K103N and V106A/M were the most common mutations. Significant risk factors associated with viremia on first-line regimen included concurrent tuberculosis treatment [odds ratio (OR) 6.4, 95% confidence interval (CI) 2.2-18.8, P < 0.01] and a recent history of poor adherence (OR 2.7, 1.3-5.6, P = 0.01). Among second-line failures, attending a public clinic (OR 4.6, 95% CI 1.8-11.3, P < 0.01) and not having a refrigerator at home (OR 6.7, 95% CI 1.2-37.5, P = 0.03) were risk factors for virological failure. Risk factors for viral failure were line regimen dependent. Second-line ART recipients had a higher rate of viremia, albeit with infrequent PI drug resistance mutations. Measures to maintain effective virologic suppression should include increased adherence counseling, attention to concomitant tuberculosis treatment and heat-stable formulations of second-line ART regimens.
    AIDS (London, England) 05/2010; 24(11):1679-87. DOI:10.1097/QAD.0b013e32833a097b · 5.55 Impact Factor
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