Economic evaluation of differentiated service delivery models for HIV treatment in Lesotho: costs to providers and patients

摘要: Introduction Lesotho, the country with second-highest HIV/AIDS prevalence (23.6%) in world, has made considerable progress towards achieving "95-95-95" UNAIDS targets, but recent success improving treatment access to all known HIV positive individuals severely strained existing healthcare infrastructure, financial and human resources. Lesotho also faces challenge of a largely rural population who incur significant time burden visit facilities. Using data from cluster-randomized non-inferiority trial conducted between August 2017 July 2019, we evaluated costs providers patients community-based differentiated models multi-month delivery antiretroviral therapy (ART) Lesotho. Methods The dispensing compared 12-month retention care among three arms: conventional care, which required quarterly facility visits ART dispensation (3MF); three-month community adherence groups (CAGs) (3MC) six-month distribution (6MCD). We first estimated average total annual cost providing followed by per patient retained 12 months after entry for each arm, using resource utilization local unit costs. then arm self-reported questionnaire data. Results was highest 3MF ($122.28, standard deviation [SD] $23.91), 3MC ($114.20, SD $23.03) 6MCD ($112.58, $21.44). Per provider $125.99 (SD $24.64) 6% 8% less other two arms ($118.38, $23.87 $118.83, $22.63 respectively). There large reduction both service $44.42 $12.06) annually $16.34 $5.11) (63% reduction) $18.77 $8.31) (58% reduction). Conclusions Community-based, are likely produce small savings Patient may support long-term care.