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[Preprint]. 2023 Dec 22:rs.3.rs-3773952.
doi: 10.21203/rs.3.rs-3773952/v1.

How much does it cost to retain antiretroviral therapy (ART) clients in care? Routine financial costs of retention interventions at Lighthouse Trust's Martin Preuss Centre (MPC) in Lilongwe, Malawi

Hiwot Weldemariam  1 , Agness Thawani  2 , Christine Kiruthu-Kamamia  2 , Jacqueline Huwa  2 , Mirriam Chipanda  2 , Hannock Tweya  3 , Caryl Feldacker  3
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How much does it cost to retain antiretroviral therapy (ART) clients in care? Routine financial costs of retention interventions at Lighthouse Trust's Martin Preuss Centre (MPC) in Lilongwe, Malawi

Hiwot Weldemariam et al. Res Sq. .

Update in

Abstract

Introduction: Antiretroviral therapy (ART) improves the health of people living with HIV (PLHIV). However, a high loss to follow-up, particularly in the first year after ART initiation, is problematic. The financial expenses related to client retention in low- and middle-income countries (LMICs) in sub-Saharan Africa are not well understood. This study aimed to comprehensively assess and quantify the financial costs associated with routine ART retention care at Lighthouse Trust's (LT) Martin Preuss Centre (MPC), a large, public ART clinic in Lilongwe, Malawi.

Methods: We performed activity-based microcosting using routine data to assess the expenses related to routine ART retention services at the MPC for 12 months, January-December 2021. MPC provides an "ART Buddy" from ART initiation to 12 months. The MPC's Back-to-Care (B2C) program traces clients who miss ART visits at any time. Clients may be traced and return to care multiple times per year. We assessed client retention costs for the first 12 months of treatment with ART and conducted a sensitivity analysis.

Results: The total annual cost of ART retention interventions at the MPC was $237,564. The proactive Buddy phase incurred $108,504; personnel costs contributed $97,764. In the reactive B2C phase, the total cost was $129,060, with personnel expenses remaining substantial at $73,778. The Buddy unit cost was $34 per client. The reactive B2C intervention was $17 per tracing event. On average, the unit cost for ART retention in the first year of ART averaged $22 per client.

Conclusion: This study sheds light on the financial dimensions of ART retention interventions at the MPC of LTs. ART retention is both costly and critical for helping clients adhere to visits and remain in care. Continued investment in the human resources needed for both proactive and reactive retention efforts is critical to engaging and retaining patients on lifetime ART.

Keywords: Malawi; activity-based costing; cost of routine health interventions; patient tracing; prevention of treatment interruption; retention in antiretroviral therapy care.

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Conflict of interest statement

Additional Declarations: No competing interests reported.

Figures

Figure 1
Figure 1
Cost drivers for proactive ART retention intervention: Buddies
Figure 2
Figure 2
Cost drivers for reactive ART retention intervention: B2C
See this image and copyright information in PMC

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References

    1. Hammond R, Harry TC. Efficacy of antiretroviral therapy in Africa: effect on immunological and virological outcome measures -- a meta-analysis. Int J STD AIDS. 2008. May;19(5):291–6. - PubMed
    1. Ivers LC, Kendrick D, Doucette K. Efficacy of antiretroviral therapy programs in resource-poor settings: a meta-analysis of the published literature. Clin Infect Dis. 2005. Jul 15;41(2):217–24. - PubMed
    1. Fox MP, Rosen S. Retention of Adult Patients on Antiretroviral Therapy in Low- and Middle-Income Countries: Systematic Review and Meta-analysis 2008–2013. J Acquir Immune Defic Syndr. 2015. May 1;69(1):98–108. - PMC - PubMed
    1. Chammartin F, Zürcher K, Keiser O, Weigel R, Chu K, Kiragga AN, et al. Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy Programs: Individual Patient Data Meta-analysis. Clin Infect Dis [Internet]. 2018. Dec 1 [cited 2023 Oct 21];67(11):1643–52. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233676/ - PMC - PubMed
    1. Brinkhof MW, Dabis F, Myer L, Bangsberg DR, Boulle A, Nash D, et al. Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries. Bulletin of the World Health Organization [Internet]. 2008. Jul [cited 2023 Oct 21];86(7):559. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647487/ - PMC - PubMed

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