Costs of home-delivered antiretroviral therapy refills for persons living with HIV: Evidence from a pilot randomized controlled trial in KwaZulu-Natal, South Africa.
Antiretroviral therapy (ART) is needed across the lifetime to maintain viral suppression for people living with HIV. In South Africa, obstacles to reliable access to ART persist and are magnified in rural areas, where HIV services are also typically costlier to deliver. A recent pilot randomized stu...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2024-01-01
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| Series: | PLOS Global Public Health |
| Online Access: | https://doi.org/10.1371/journal.pgph.0003368 |
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| author | Ashley S Tseng Ruanne V Barnabas Alastair van Heerden Xolani Ntinga Maitreyi Sahu |
| author_facet | Ashley S Tseng Ruanne V Barnabas Alastair van Heerden Xolani Ntinga Maitreyi Sahu |
| author_sort | Ashley S Tseng |
| collection | DOAJ |
| description | Antiretroviral therapy (ART) is needed across the lifetime to maintain viral suppression for people living with HIV. In South Africa, obstacles to reliable access to ART persist and are magnified in rural areas, where HIV services are also typically costlier to deliver. A recent pilot randomized study (the Deliver Health Study) found that home-delivered ART refills, provided at a low user fee, effectively overcame logistical barriers to access and improved clinical outcomes in rural South Africa. In the present costing study using the provider perspective, we conducted retrospective activity-based micro-costing of home-delivered ART within the Deliver Health Study and when provided at-scale (in a rural setting), and compared to facility-based costs using provincial expenditure data (covering both rural and urban settings). Within the context of the pilot Deliver Health Study which had an average of three deliveries per day for three days a week, home-delivered ART cost (in 2022 USD) $794 in the first year and $714 for subsequent years per client after subtracting client fees, compared with $167 per client in provincial clinic-based care. We estimated that home-delivered ART can reasonably be scaled up to 12 home deliveries per day for five days per week in the rural setting. When delivered at-scale, home-delivered ART cost $267 in the first year and $183 for subsequent years per client. Average costs of home delivery further decreased when increasing the duration of refills from three-months to six- and 12-month scripts (from $183 to $177 and $135 per client, respectively). Personnel costs were the largest cost for home-delivered refills while ART drug costs were the largest cost of clinic-based refills. When provided at-scale, home-delivered ART in a rural setting not only offers clinical benefits for a hard-to-reach population but is also comparable in cost to the provincial standard of care. |
| format | Article |
| id | doaj-art-66359cb5b8734b1691089e0c1dc2a400 |
| institution | Kabale University |
| issn | 2767-3375 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj-art-66359cb5b8734b1691089e0c1dc2a4002025-01-18T05:48:34ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752024-01-01412e000336810.1371/journal.pgph.0003368Costs of home-delivered antiretroviral therapy refills for persons living with HIV: Evidence from a pilot randomized controlled trial in KwaZulu-Natal, South Africa.Ashley S TsengRuanne V BarnabasAlastair van HeerdenXolani NtingaMaitreyi SahuAntiretroviral therapy (ART) is needed across the lifetime to maintain viral suppression for people living with HIV. In South Africa, obstacles to reliable access to ART persist and are magnified in rural areas, where HIV services are also typically costlier to deliver. A recent pilot randomized study (the Deliver Health Study) found that home-delivered ART refills, provided at a low user fee, effectively overcame logistical barriers to access and improved clinical outcomes in rural South Africa. In the present costing study using the provider perspective, we conducted retrospective activity-based micro-costing of home-delivered ART within the Deliver Health Study and when provided at-scale (in a rural setting), and compared to facility-based costs using provincial expenditure data (covering both rural and urban settings). Within the context of the pilot Deliver Health Study which had an average of three deliveries per day for three days a week, home-delivered ART cost (in 2022 USD) $794 in the first year and $714 for subsequent years per client after subtracting client fees, compared with $167 per client in provincial clinic-based care. We estimated that home-delivered ART can reasonably be scaled up to 12 home deliveries per day for five days per week in the rural setting. When delivered at-scale, home-delivered ART cost $267 in the first year and $183 for subsequent years per client. Average costs of home delivery further decreased when increasing the duration of refills from three-months to six- and 12-month scripts (from $183 to $177 and $135 per client, respectively). Personnel costs were the largest cost for home-delivered refills while ART drug costs were the largest cost of clinic-based refills. When provided at-scale, home-delivered ART in a rural setting not only offers clinical benefits for a hard-to-reach population but is also comparable in cost to the provincial standard of care.https://doi.org/10.1371/journal.pgph.0003368 |
| spellingShingle | Ashley S Tseng Ruanne V Barnabas Alastair van Heerden Xolani Ntinga Maitreyi Sahu Costs of home-delivered antiretroviral therapy refills for persons living with HIV: Evidence from a pilot randomized controlled trial in KwaZulu-Natal, South Africa. PLOS Global Public Health |
| title | Costs of home-delivered antiretroviral therapy refills for persons living with HIV: Evidence from a pilot randomized controlled trial in KwaZulu-Natal, South Africa. |
| title_full | Costs of home-delivered antiretroviral therapy refills for persons living with HIV: Evidence from a pilot randomized controlled trial in KwaZulu-Natal, South Africa. |
| title_fullStr | Costs of home-delivered antiretroviral therapy refills for persons living with HIV: Evidence from a pilot randomized controlled trial in KwaZulu-Natal, South Africa. |
| title_full_unstemmed | Costs of home-delivered antiretroviral therapy refills for persons living with HIV: Evidence from a pilot randomized controlled trial in KwaZulu-Natal, South Africa. |
| title_short | Costs of home-delivered antiretroviral therapy refills for persons living with HIV: Evidence from a pilot randomized controlled trial in KwaZulu-Natal, South Africa. |
| title_sort | costs of home delivered antiretroviral therapy refills for persons living with hiv evidence from a pilot randomized controlled trial in kwazulu natal south africa |
| url | https://doi.org/10.1371/journal.pgph.0003368 |
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