Shrestha Ram K, Gardner Lytt, Marks Gary, Craw Jason, Malitz Faye, Giordano Thomas P, Sullivan Meg, Keruly Jeanne, Rodriguez Allan, Wilson Tracey E, Mugavero Michael
*Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA; †HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD; ‡Department of Medicine, Baylor College of Medicine, Houston, TX; §Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; ‖Department of Medicine, Boston University School of Medicine, Boston, MA; ¶Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; #Division of Infectious Diseases, Miller School of Medicine, University of Miami, Miami, FL; **Department of Community Health Sciences, SUNY Downstate Medical Center School of Public Health, Brooklyn, NY; and ††Division of Infectious Diseases, Department of Medicine, University of Alabama-Birmingham, Birmingham, AL.
J Acquir Immune Defic Syndr. 2015 Mar 1;68(3):345-50. doi: 10.1097/QAI.0000000000000462.
Retaining HIV patients in medical care promotes access to antiretroviral therapy, viral load suppression, and reduced HIV transmission to partners. We estimate the programmatic costs of a US multisite randomized controlled trial of an intervention to retain HIV patients in care.
Six academically affiliated HIV clinics randomized patients to intervention (enhanced personal contact with patients across time coupled with basic HIV education) and control [standard of care (SOC)] arms. Retention in care was defined as 4-month visit constancy, that is, at least 1 primary care visit in each 4-month interval over a 12-month period. We used microcosting methods to collect unit costs and measure the quantity of resources used to implement the intervention in each clinic. All fixed and variable labor and nonlabor costs of the intervention were included.
Visit constancy was achieved by 45.7% (280/613) of patients in the SOC arm and by 55.8% (343/615) of patients in the intervention arm, representing an increase of 63 patients (relative improvement 22.1%; 95% confidence interval: 9% to 36%; P < 0.01). The total annual cost of the intervention at the 6 clinics was $241,565, the average cost per patient was $393, and the estimated cost per additional patient retained in care beyond SOC was $3834.
Our analyses showed that a retention in care intervention consisting of enhanced personal contact coupled with basic HIV education may be delivered at fairly low cost. These results provide useful information for guiding decisions about planning or scaling-up retention in care interventions for HIV-infected patients.
使艾滋病病毒（HIV）感染者持续接受医疗护理有助于他们获得抗逆转录病毒治疗、抑制病毒载量，并减少将HIV传播给性伴侣。我们估算了一项美国多中心随机对照试验的项目成本，该试验旨在采用一种干预措施使HIV感染者持续接受医疗护理。
6家学术附属HIV诊所将患者随机分为干预组（随着时间推移加强与患者的个人联系并开展基本的HIV教育）和对照组[标准护理（SOC）组]。持续接受护理的定义为4个月就诊连续性，即在12个月期间内每4个月至少进行1次初级保健就诊。我们采用微观成本核算方法收集单位成本，并衡量各诊所实施干预措施所使用的资源数量。干预措施的所有固定和可变人力及非人力成本均包括在内。
SOC组45.7%（280/613）的患者实现了就诊连续性，干预组为55.8%（343/615）的患者，这意味着增加了63名患者（相对改善22.1%；95%置信区间：9%至36%；P < 0.01）。6家诊所干预措施的年度总成本为241,565美元，每名患者的平均成本为393美元，估计在SOC基础上每多留住1名接受护理的患者成本为3834美元。
我们的分析表明，由加强个人联系和基本HIV教育组成的持续护理干预措施成本可能相当低。这些结果为指导有关规划或扩大针对HIV感染者的持续护理干预措施的决策提供了有用信息。
