尼加拉瓜集中式病毒载量检测用于抗逆转录病毒治疗监测的成本分析，该国 HIV 感染率低，资源有限。
Cost analysis of centralized viral load testing for antiretroviral therapy monitoring in Nicaragua, a low-HIV prevalence, low-resource setting.
机构信息
Programs for Appropriate Technologies in Health (PATH), Seattle, Washington 98121, USA.
PATH, Managua, Nicaragua.
出版信息
J Int AIDS Soc. 2010 Nov 5;13:43. doi: 10.1186/1758-2652-13-43.
BACKGROUND
HIV viral load testing as a component of antiretroviral therapy monitoring is costly. Understanding the full costs and the major sources of inefficiency associated with viral load testing is critical for optimizing the systems and technologies that support the testing process. The objective of our study was to estimate the costs associated with viral load testing performed for antiretroviral therapy monitoring to both patients and the public healthcare system in a low-HIV prevalence, low-resource country.
METHODS
A detailed cost analysis was performed to understand the costs involved in each step of performing a viral load test in Nicaragua, from initial specimen collection to communication of the test results to each patient's healthcare provider. Data were compiled and cross referenced from multiple information sources: laboratory records, regional surveillance centre records, and scheduled interviews with the key healthcare providers responsible for HIV patient care in five regions of the country.
RESULTS
The total average cost of performing a viral load test in Nicaragua varied by region, ranging from US$99.01 to US$124.58, the majority of which was at the laboratory level: $88.73 to $97.15 per specimen, depending on batch size. The average cost to clinics at which specimens were collected ranged from $3.31 to $20.92, depending on the region. The average cost per patient for transportation, food, lodging and lost income ranged from $3.70 to $14.93.
CONCLUSIONS
The quantitative viral load test remains the single most expensive component of the process. For the patient, the distance of his or her residence from the specimen collection site is a large determinant of cost. Importantly, the efficiency of results reporting has a large impact on the cost per result delivered to the clinician and utility of the result for patient monitoring. Detailed cost analysis can identify opportunities for removing barriers to effective antiretroviral therapy monitoring programmes in limited-resource countries with low HIV prevalence.
背景
艾滋病毒病毒载量检测作为抗逆转录病毒治疗监测的一个组成部分，成本很高。了解与病毒载量检测相关的全部成本和主要效率低下的原因，对于优化支持检测过程的系统和技术至关重要。我们的研究目的是估算在艾滋病毒低流行、资源有限的国家，为进行抗逆转录病毒治疗监测而进行病毒载量检测对患者和公共卫生保健系统造成的相关成本。
方法
我们进行了详细的成本分析，以了解在尼加拉瓜进行病毒载量检测的每个步骤所涉及的成本，从初始标本采集到将检测结果传达给每位患者的医疗保健提供者。数据是从多个信息来源汇编和交叉引用的：实验室记录、区域监测中心记录以及对负责该国五个地区艾滋病毒患者护理的关键医疗保健提供者进行的定期访谈。
结果
在尼加拉瓜进行病毒载量检测的总平均成本因地区而异，范围从 99.01 美元到 124.58 美元不等，其中大部分成本都发生在实验室：根据批次大小，每个标本的成本在 88.73 美元到 97.15 美元之间。标本采集诊所的平均成本取决于地区，从 3.31 美元到 20.92 美元不等。每位患者的交通、食品、住宿和收入损失费用从 3.70 美元到 14.93 美元不等。
结论
定量病毒载量检测仍然是该过程中最昂贵的单项成本。对于患者而言，其居住地点与标本采集地点的距离是决定成本的重要因素。重要的是，结果报告的效率对向临床医生提供的每个检测结果的成本以及该结果对患者监测的实用性有很大影响。详细的成本分析可以确定在艾滋病毒低流行、资源有限的国家消除有效抗逆转录病毒治疗监测计划障碍的机会。
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