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. 2019 Dec;82 Suppl 3(Suppl 3):S339-S347.
doi: 10.1097/QAI.0000000000002195.

Cost of Differentiated HIV Antiretroviral Therapy Delivery Strategies in Sub-Saharan Africa: A Systematic Review

D Allen Roberts  1 , Nicholas Tan  2 , Nishaant Limaye  2 , Elizabeth Irungu  2 , Ruanne V Barnabas  1   2   3
Affiliations

Cost of Differentiated HIV Antiretroviral Therapy Delivery Strategies in Sub-Saharan Africa: A Systematic Review

D Allen Roberts et al. J Acquir Immune Defic Syndr. 2019 Dec.

Abstract

Background: Efficient and scalable models for HIV treatment are needed to maximize health outcomes with available resources. By adapting services to client needs, differentiated antiretroviral therapy (DART) has the potential to use resources more efficiently. We conducted a systematic review assessing the cost of DART in sub-Saharan Africa compared with the standard of care.

Methods: We searched PubMed, Embase, Global Health, EconLit, and the grey literature for studies published between 2005 and 2019 that assessed the cost of DART. Models were classified as facility-vs. community-based and individual- vs group-based. We extracted the annual per-patient service delivery cost and incremental cost of DART compared with standard of care in 2018 USD.

Results: We identified 12 articles that reported costs for 16 DART models in 7 countries. The majority of models were facility-based (n = 12) and located in Uganda (n = 7). The annual cost per patient within DART models (excluding drugs) ranged from $27 to $889 (2018 USD). Of the 11 models reporting incremental costs, 7 found DART to be cost saving. The median incremental saving per patient per year among cost-saving models was $67. Personnel was the most common driver of reduced costs, but savings were sometimes offset by higher overheads or utilization.

Conclusions: DART models can save personnel costs by task shifting and reducing visit frequency. Additional economic evidence from community-based and group models is needed to better understand the scalability of DART. To decrease costs, programs will need to match DART models to client needs without incurring substantial overheads.

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Conflict of interest statement

Conflicts of interest: The authors declare no conflicts of interest.

Figures

Figure 1:
Figure 1:
Differentiated ART delivery framework (courtesy of ICAP at Columbia University)
Figure 2:
Figure 2:
PRISMA flow diagram for the selection of studies on the cost of differentiated ART delivery strategies in sub-Saharan Africa
See this image and copyright information in PMC

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