Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark.
PLoS One. 2020 Oct 29;15(10):e0238499. doi: 10.1371/journal.pone.0238499. eCollection 2020.
Great strides in responding to the HIV epidemic have led to improved access to and uptake of HIV services in Guyana, a lower-middle-income country with a generalized HIV epidemic. Despite efforts to scale up HIV treatment and adopt the test and start strategy, little is known about costs of HIV services across the care cascade.
We collected cost data from the national laboratory and nine selected treatment facilities in five of the country's ten Regions, and estimated the costs associated with HIV testing and services (HTS) and antiretroviral therapy (ART) from a provider perspective from January 1, 2016 to December 31, 2016. We then used the unit costs to construct four resource allocation scenarios. In the first two scenarios, we calculated how close Guyana would currently be to its 2020 targets if the allocation of funding across programs and regions over 2017-2020 had (a) remained unchanged from latest-reported levels, or (b) been optimally distributed to minimize incidence and deaths. In the next two, we estimated the resources that would have been required to meet the 2020 targets if those resources had been distributed (a) according to latest-reported patterns, or (b) optimally to minimize incidence and deaths.
The mean cost per test was US$15 and the mean cost per person tested positive was US$796. The mean annual cost per of maintaining established adult and pediatric patients on ART were US$428 and US$410, respectively. The mean annual cost of maintaining virally suppressed patients was US$648. Cost variation across sites may suggest opportunities for improvements in efficiency, or may reflect variation in facility type and patient volume. There may also be scope for improvements in allocative efficiency; we estimated a 28% reduction in the total resources required to meet Guyana's 2020 targets if funds had been optimally distributed to minimize infections and deaths.
We provide the first estimates of costs along the HIV cascade in the Caribbean and assessed efficiencies using novel context-specific data on the costs associated with diagnostic, treatment, and viral suppression. The findings call for better targeting of services, and efficient service delivery models and resource allocation, while scaling up HIV services to maximize investment impact.
在圭亚那，艾滋病毒应对工作取得了重大进展，艾滋病毒服务的可及性和利用率得到提高，圭亚那是一个中低收入国家，艾滋病毒流行广泛。尽管努力扩大艾滋病毒治疗规模并采用检测和启动战略，但对整个护理链中艾滋病毒服务的成本知之甚少。
我们从国家实验室和该国五个地区的九个选定治疗设施收集了成本数据，并从提供者的角度估算了 2016 年 1 月 1 日至 2016 年 12 月 31 日期间与艾滋病毒检测和服务（HTS）以及抗逆转录病毒治疗（ART）相关的成本。然后，我们使用单位成本构建了四个资源分配方案。在头两个方案中，我们计算了如果 2017-2020 年期间方案和地区之间的资金分配（a）保持最新报告水平不变，或者（b）最优分配以最大限度地减少发病率和死亡率，圭亚那目前将接近其 2020 年目标的程度。在接下来的两个方案中，我们估计了如果资源（a）根据最新报告模式分配，或者（b）最优分配以最大限度地减少发病率和死亡率，将满足 2020 年目标所需的资源。
每次检测的平均费用为 15 美元，每次检测阳性的平均费用为 796 美元。维持成年和儿科患者接受抗逆转录病毒治疗的每年平均费用分别为 428 美元和 410 美元。维持病毒抑制患者的年平均费用为 648 美元。不同地点的成本差异可能表明提高效率的机会，或者可能反映设施类型和患者数量的差异。在资源分配效率方面也可能有改进的空间；我们估计，如果资金最优分配以最大限度地减少感染和死亡，满足圭亚那 2020 年目标所需的总资源将减少 28%。
我们提供了加勒比地区艾滋病毒护理链成本的首次估计，并使用与诊断、治疗和病毒抑制相关成本的新型特定于上下文的数据评估了效率。这些发现呼吁更好地针对服务，并提高服务提供模式和资源分配的效率，同时扩大艾滋病毒服务规模，以最大限度地提高投资效果。
