Cianci Fiona, Sweeney Sedona, Konate Issouf, Nagot Nicolas, Low Andrea, Mayaud Philippe, Vickerman Peter
Social and Mathematical Epidemiology Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
UR-VIH/MA, Centre Muraz, Bobo-Dioulasso, Burkina Faso.
PLoS One. 2014 Jun 20;9(6):e100107. doi: 10.1371/journal.pone.0100107. eCollection 2014.
Female Sex workers (FSW) are important in driving HIV transmission in West Africa. The Yerelon clinic in Burkina Faso has provided combined preventative and therapeutic services, including anti-retroviral therapy (ART), for FSWs since 1998, with evidence suggesting it has decreased HIV prevalence and incidence in this group. No data exists on the costs of such a combined prevention and treatment intervention for FSW. This study aims to determine the mean cost of service provision per patient year for FSWs attending the Yerelon clinic, and identifies differences in costs between patient groups.
Field-based retrospective cost analyses were undertaken using top-down and bottom-up costing approaches for 2010. Expenditure and service utilisation data was collated from primary sources. Patients were divided into groups according to full-time or occasional sex-work, HIV status and ART duration. Patient specific service use data was extracted. Costs were converted to 2012 US$. Sensitivity analyses considered removal of all research costs, different discount rates and use of different ART treatment regimens and follow-up schedules.
Using the top-down costing approach, the mean annual cost of service provision for FSWs on or off ART was US$1098 and US$882, respectively. The cost for FSWs on ART reduced by 29%, to US$781, if all research-related costs were removed and national ART monitoring guidelines were followed. The bottom-up patient-level costing showed the cost of the service varied greatly across patient groups (US$505-US$1117), primarily due to large differences in the costs of different ART regimens. HIV-negative women had the lowest annual cost at US$505.
Whilst FSWs may require specialised services to optimise their care and hence, the public health benefits, our study shows that the cost of ART provision within a combined prevention and treatment intervention setting is comparable to providing ART to other population groups in Africa.
女性性工作者是推动西非地区艾滋病病毒传播的重要群体。自1998年以来，布基纳法索的耶雷隆诊所一直为女性性工作者提供预防和治疗相结合的服务，包括抗逆转录病毒疗法（ART），有证据表明这一举措降低了该群体中艾滋病病毒的流行率和发病率。目前尚无关于针对女性性工作者的这种预防与治疗相结合干预措施成本的数据。本研究旨在确定耶雷隆诊所女性性工作者每位患者每年的平均服务提供成本，并找出不同患者群体之间的成本差异。
采用自上而下和自下而上的成本核算方法，对2010年进行基于实地的回顾性成本分析。从主要来源整理支出和服务利用数据。根据全职或兼职性工作、艾滋病病毒感染状况和抗逆转录病毒疗法疗程，将患者分为不同组。提取患者特定的服务使用数据。成本换算为2012年美元。敏感性分析考虑了去除所有研究成本、不同的贴现率以及使用不同的抗逆转录病毒疗法治疗方案和随访时间表。
采用自上而下的成本核算方法，接受或未接受抗逆转录病毒疗法的女性性工作者的平均年度服务提供成本分别为1098美元和882美元。如果去除所有与研究相关的成本并遵循国家抗逆转录病毒疗法监测指南，接受抗逆转录病毒疗法的女性性工作者的成本降低29%，降至781美元。自下而上的患者层面成本核算显示，不同患者群体的服务成本差异很大（505美元至1117美元），主要原因是不同抗逆转录病毒疗法方案的成本差异很大。艾滋病病毒阴性女性的年度成本最低，为505美元。
虽然女性性工作者可能需要专门服务以优化其护理从而获得公共卫生效益，但我们的研究表明，在预防与治疗相结合的干预环境中提供抗逆转录病毒疗法的成本与在非洲向其他人群提供抗逆转录病毒疗法的成本相当。
