Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
Faculty of Health Sciences, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2021 Mar 18;16(3):e0248551. doi: 10.1371/journal.pone.0248551. eCollection 2021.
In 2016, under its new National Adherence Guidelines (AGL), South Africa formalized an existing model of fast-track HIV treatment initiation counselling (FTIC). Rollout of the AGL included an evaluation study at 24 clinics, with staggered AGL implementation. Using routinely collected data extracted as part of the evaluation study, we estimated and compared the costs of HIV care and treatment from the provider's perspective at the 12 clinics implementing the new, formalized model (AGL-FTIC) to costs at the 12 clinics continuing to implement some earlier, less formalized, model that likely varied across clinics (denoted here as early-FTIC).
This was a cost-outcome analysis using standard methods and a composite outcome defined as initiated antiretroviral therapy (ART) within 30 days of treatment eligibility and retained in care at 9 months. Using patient-level, bottom-up resource-utilization data and local unit costs, we estimated patient-level costs of care and treatment in 2017 U.S. dollars over the 9-month evaluation follow-up period for the two models of care. Resource use and costs, disaggregated by antiretroviral medications, laboratory tests, and clinic visits, are reported by model of care and stratified by the composite outcome.
A total of 350/343 patients in the early-FTIC/AGL-FTIC models of care are included in this analysis. Mean/median costs were similar for both models of care ($135/$153 for early-FTIC, $130/$151 for AGL-FTIC). For the subset achieving the composite outcome, resource use and therefore mean/median costs were similar but slightly higher, reflecting care consistent with treatment guidelines ($163/$166 for early-FTIC, $168/$170 for AGL-FTIC). Not surprisingly, costs for patients not achieving the composite outcome were substantially less, mainly because they only had two or fewer follow-up visits and, therefore, received substantially less ART than patients who achieved the composite outcome.
The 2016 adherence guidelines clarified expectations for the content and timing of adherence counseling sessions in relation to ART initiation. Because clinics were already initiating patients on ART quickly by 2016, little room existed for the new model of fast-track initiation counseling to reduce the number of pre-ART clinic visits at the study sites and therefore to reduce costs of care and treatment.
Clinical Trial Number: NCT02536768.
2016 年，南非在新的国家依从性指南（AGL）下，将快速启动 HIV 治疗咨询（FTIC）的现有模式正式化。AGL 的推出包括在 24 个诊所进行评估研究，分阶段实施 AGL。利用评估研究中提取的常规收集数据，我们从提供者的角度估计和比较了在实施新的、正式模型（AGL-FTIC）的 12 个诊所和继续实施一些早期、不太正式、可能因诊所而异的模型（此处表示为早期-FTIC）的 HIV 护理和治疗的成本。
这是一项成本效益分析，使用标准方法和定义为在治疗资格后 30 天内启动抗逆转录病毒治疗（ART）和在 9 个月时保留在护理中的综合结果。使用患者层面的自下而上资源利用数据和当地单位成本，我们在 9 个月的评估随访期间，根据两种护理模式估计了患者在 2017 年的护理和治疗的患者层面成本。按护理模式和综合结果进行分层，报告了抗逆转录病毒药物、实验室测试和诊所就诊的资源使用和成本。
在早期-FTIC/AGL-FTIC 护理模式中，共有 350/343 名患者纳入本分析。两种护理模式的平均/中位数成本相似（早期-FTIC 为 135/153 美元，AGL-FTIC 为 130/151 美元）。对于达到综合结果的亚组，资源使用情况因此平均/中位数成本相似，但略高，反映了符合治疗指南的护理（早期-FTIC 为 163/166 美元，AGL-FTIC 为 168/170 美元）。毫不奇怪，未达到综合结果的患者的成本要低得多，主要是因为他们只有两次或更少的随访就诊，因此接受的 ART 明显少于达到综合结果的患者。
2016 年的依从性指南明确了与 ART 启动相关的依从性咨询会议内容和时间的期望。由于到 2016 年，诊所已经快速启动了患者的 ART，新的快速启动咨询模式几乎没有减少研究点的 ART 前诊所就诊次数的空间，因此也没有降低护理和治疗的成本。
临床试验编号：NCT02536768。
