Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 13;24(1):1392.
doi: 10.1186/s12913-024-11825-z.

Cost analysis of adding hypertension and diabetes management into routine HIV care in Mbarara and Ibanda districts, Uganda

Mackline Ninsiima  1 , Soumava Basu  2 , Muhammad Jami Husain  2 , Peter Chris Kawungezi  3 , Zainah Kabami  3 , Brenda Nakafeero Simbwa  3 , Lilian Bulage  3 , Meredith Kruse  2 , Sonia Tetlow  2 , Daniel Kadobera  3 , Mina Ssali  4 , Richard Migisha  3 , Alex Riolexus Ario  3 , Deliana Kostova  2
Affiliations

Cost analysis of adding hypertension and diabetes management into routine HIV care in Mbarara and Ibanda districts, Uganda

Mackline Ninsiima et al. BMC Health Serv Res. .

Abstract

Background: In 2016, Uganda introduced services for hypertension and diabetes in selected HIV clinics. We evaluated the costs associated with scaling up these services in HIV clinics in Mbarara and Ibanda districts, Uganda.

Methods: We estimated the annual costs of providing hypertension and diabetes services using an activity-based costing approach from the health system perspective in ten randomly selected HIV clinics in Mbarara and Ibanda districts. Cost inputs included 2023 data on costs of medications, health provider time, salaries, training costs, and monitoring costs. We determined the average annual cost and medication costs for hypertension and diabetes treatment per enrolled adult patient, stratified by type of health facility.

Results: The total annual cost of hypertension and diabetes management services in ten selected HIV clinics was estimated to be $413,850 (range: $8,386 - 186,973). The annual average clinic-level cost per enrolled patient was estimated at $14 (range: $7 - 31). Of the total annual cost, the cost of provider time for initial and follow-up visits represented the largest cost component in 5/10 clinics (mean: 37%, range [13-58%]). In 4/10 clinics, the major cost components were the costs of medication, diagnostic tests, and related supplies (mean: 37%, range [10-75%]). The average cost per enrolled adult patient was $11 at public facilities and $21 in private not-for-profit facilities. The average medication cost per patient for hypertension was $24 (range: $7 - 97) annually; $13 at public facilities and $50 at private not-for-profit facilities. For diabetes treatment, the average annual medication cost per patient was estimated at $14 (range: $6 - 35); $11 at public facilities and $22 at private not-for-profit facilities.

Conclusion: Adding hypertension and diabetes management to routine HIV care might be feasible based on the estimated annual cost per patient. Hypertension and diabetes treatment was more costly in private not-for-profit facility-based clinics than at public facilities. This variation was primarily driven by higher medication procurement prices at private facilities, revealing a potential area for optimizing costs through improved procurement practices.

Keywords: Cost analysis; Diabetes; HIV; Hypertension; Uganda.

PubMed Disclaimer

Conflict of interest statement

Declarations Ethics approval and consent to participate The Uganda National Institute of Public Health (UNIPH) operates under the Ministry of Health (MoH); in essence, the UNIPH is a subordinate authority to MoH. The MoH authorized the cost analysis to inform HIV programming, and UNIPH approved the study and its protocols. We extracted health facility cost data and other parameters that did not require individual participant consent. This analysis was classified as non-research, and as per our memorandum of understanding, it was exempt from full Institutional Review Board review, primarily aimed at public health practice. We obtained administrative clearance from the District Health Officers of Mbarara and Ibanda districts, as well as from the in-charges of selected HIV clinics. All methods were conducted in accordance with the approval and administrative clearance without any ethical breach. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy. §§See e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. § 241(d); 5 U.S.C. § 552a; 44 U.S.C. § 3501 et seq. Consent for publication Not applicable. Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of annual costs by HEARTS components for hypertension and diabetes management into routine HIV care Appendix Table 1: Cost analysis inputs
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Duffy M, Ojikutu B, Andrian S, Sohng E, Minior T, Hirschhorn LR. <ArticleTitle Language=“En”>Non-communicable diseases and HIV care and treatment: models of integrated service delivery. Tropical Med Int Health. 2017;22(8):926–37. - PubMed
    1. Haldane V, Legido-Quigley H, Chuah FLH, Sigfrid L, Murphy G, Ong SE, et al. Integrating cardiovascular diseases, hypertension, and diabetes with HIV services: a systematic review. AIDS Care. 2018;30(1):103–15. - PubMed
    1. Monroe AK, Glesby MJ, Brown TT. Diagnosing and managing diabetes in HIV-infected patients: current concepts. Clin Infect Dis. 2015;60(3):453–62. - PubMed
    1. Sarkar S, Brown TT. Diabetes in people living with HIV. Endotext. 2019.
    1. Davis K, Perez-Guzman P, Hoyer A, Brinks R, Gregg E, Althoff KN, et al. Association between HIV infection and hypertension: a global systematic review and meta-analysis of cross-sectional studies. BMC Med. 2021;19(1):1–16. - PMC - PubMed

Substances

LinkOut - more resources