Center for Integration Science, Brigham and Women's Hospital, Boston, MA, 02115, USA.
Institute for Global Health and Development, Brandeis University, Waltham, MA, USA.
AIDS Behav. 2023 Oct;27(10):3498-3507. doi: 10.1007/s10461-023-04065-5. Epub 2023 May 5.
Using time-driven activity-based costing (TDABC), we examined resource allocation and costs for HIV services throughout Tanzania at patient and facility levels. This national, cross-sectional analysis of 22 health facilities quantified costs and resources associated with 886 patients receiving care for five HIV services: antiretroviral therapy, prevention of mother-to-child transmission, HIV testing and counseling, voluntary medical male circumcision, and pre-exposure prophylaxis. We also documented total provider-patient interaction time, the cost of services with and without inclusion of consumables, and conducted fixed-effects multivariable regression analyses to examine patient- and facility-level correlates of costs and provider-patient time. Findings showed that resources and costs for HIV care varied significantly throughout Tanzania, including as a function of patient- and facility-level characteristics. While some variation may be preferable (e.g., needier patients received more resources), other areas suggested a lack of equity (e.g., wealthier patients received more provider time) and presented opportunities to optimize care delivery protocols.
采用时间驱动作业成本法（TDABC），我们在患者和医疗机构两个层面上，对坦桑尼亚全国的艾滋病毒服务资源分配和成本进行了考察。本项全国性、跨部门分析选取了 22 个卫生机构，对 886 名接受五种艾滋病毒服务（抗逆转录病毒治疗、母婴传播预防、艾滋病毒检测和咨询、男性自愿医疗环切术以及暴露前预防）的患者，对相关成本和资源进行了量化。我们还记录了总服务提供者与患者之间的互动时间、包含和不包含消耗品的服务成本，并开展了固定效应多变量回归分析，以考察患者和医疗机构层面的成本和服务提供者与患者之间互动时间的相关因素。研究结果表明，坦桑尼亚各地艾滋病毒护理的资源和成本存在显著差异，包括患者和医疗机构特征等方面的差异。尽管某些差异可能是可取的（例如，更有需要的患者得到更多资源），但其他方面则表明缺乏公平性（例如，较富裕的患者得到更多服务提供者的时间），并为优化护理服务提供了机会。
