Economic evaluation of integrated services for non-communicable diseases and HIV: costs and client outcomes in rural Malawi
Objective To evaluate the costs and client outcomes associated with integrating screening and treatment for non-communicable diseases (NCDs) into HIV services in a rural and remote part in southeastern Africa.Design Prospective cohort study.Setting Primary and secondary level health facilities in Ne...
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BMJ Publishing Group
2022-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/11/e063701.full |
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| author | Luckson Dullie Emily B Wroe Elizabeth L Dunbar Noel Kalanga Lawrence Nazimera Adarsh Shah Bright Mailosi Chiyembekezo Kachimanga Ryan K McBain Natalie Price Mahlet Gizaw Chantelle Boudreaux Liberty Neba |
| author_facet | Luckson Dullie Emily B Wroe Elizabeth L Dunbar Noel Kalanga Lawrence Nazimera Adarsh Shah Bright Mailosi Chiyembekezo Kachimanga Ryan K McBain Natalie Price Mahlet Gizaw Chantelle Boudreaux Liberty Neba |
| author_sort | Luckson Dullie |
| collection | DOAJ |
| description | Objective To evaluate the costs and client outcomes associated with integrating screening and treatment for non-communicable diseases (NCDs) into HIV services in a rural and remote part in southeastern Africa.Design Prospective cohort study.Setting Primary and secondary level health facilities in Neno District, Malawi.Participants New adult enrollees in Integrated Chronic Care Clinics (IC3) between July 2016 and June 2017.Main outcome measures We quantified the annualised total and per capita economic cost (US$2017) of integrated chronic care, using activity-based costing from a health system perspective. We also measured enrolment, retention and mortality over the same period. Furthermore, we measured clinical outcomes for HIV (viral load), hypertension (controlled blood pressure), diabetes (average blood glucose), asthma (asthma severity) and epilepsy (seizure frequency).Results The annualised total cost of providing integrated HIV and NCD care was $2 461 901 to provide care to 9471 enrollees, or $260 per capita. This compared with $2 138 907 for standalone HIV services received by 6541 individuals, or $327 per capita. Over the 12-month period, 1970 new clients were enrolled in IC3, with a retention rate of 80%. Among clients with HIV, 81% achieved an undetectable viral load within their first year of enrolment. Significant improvements were observed among clinical outcomes for clients enrolled with hypertension, asthma and epilepsy (p<0.05, in all instances), but not for diabetes (p>0.05).Conclusions IC3 is one of the largest examples of fully integrated HIV and NCD care. Integrating screening and treatment for chronic health conditions into Malawi’s HIV platform appears to be a financially feasible approach associated with several positive clinical outcomes. |
| format | Article |
| id | doaj-art-bb4bbd0289e043aa9c1c90bd9a84f58d |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-bb4bbd0289e043aa9c1c90bd9a84f58d2025-02-07T08:15:16ZengBMJ Publishing GroupBMJ Open2044-60552022-11-01121110.1136/bmjopen-2022-063701Economic evaluation of integrated services for non-communicable diseases and HIV: costs and client outcomes in rural MalawiLuckson Dullie0Emily B Wroe1Elizabeth L Dunbar2Noel Kalanga3Lawrence Nazimera4Adarsh Shah5Bright Mailosi6Chiyembekezo Kachimanga7Ryan K McBain8Natalie Price9Mahlet Gizaw10Chantelle Boudreaux11Liberty Neba12Partners In Health, Neno, MalawiPartners In Health, Neno, MalawiPartners In Health, Neno, MalawiDepartment of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, MalawiMinistry of Health, Neno, MalawiPartners In Health, Boston, Massachusetts, USA2 Partners In Health, Neno, MalawiPartners In Health, Neno, MalawiDepartment of Internal Medicine, Brigham and Women`s Hospital, Boston, Massachusetts, USADepartment of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USARAND Corporation, Santa Monica, California, USACenter for Integration Science, Brigham and Women`s Hospital, Boston, Massachusetts, USAClinton Health Access Initiative, Lilongwe, MalawiObjective To evaluate the costs and client outcomes associated with integrating screening and treatment for non-communicable diseases (NCDs) into HIV services in a rural and remote part in southeastern Africa.Design Prospective cohort study.Setting Primary and secondary level health facilities in Neno District, Malawi.Participants New adult enrollees in Integrated Chronic Care Clinics (IC3) between July 2016 and June 2017.Main outcome measures We quantified the annualised total and per capita economic cost (US$2017) of integrated chronic care, using activity-based costing from a health system perspective. We also measured enrolment, retention and mortality over the same period. Furthermore, we measured clinical outcomes for HIV (viral load), hypertension (controlled blood pressure), diabetes (average blood glucose), asthma (asthma severity) and epilepsy (seizure frequency).Results The annualised total cost of providing integrated HIV and NCD care was $2 461 901 to provide care to 9471 enrollees, or $260 per capita. This compared with $2 138 907 for standalone HIV services received by 6541 individuals, or $327 per capita. Over the 12-month period, 1970 new clients were enrolled in IC3, with a retention rate of 80%. Among clients with HIV, 81% achieved an undetectable viral load within their first year of enrolment. Significant improvements were observed among clinical outcomes for clients enrolled with hypertension, asthma and epilepsy (p<0.05, in all instances), but not for diabetes (p>0.05).Conclusions IC3 is one of the largest examples of fully integrated HIV and NCD care. Integrating screening and treatment for chronic health conditions into Malawi’s HIV platform appears to be a financially feasible approach associated with several positive clinical outcomes.https://bmjopen.bmj.com/content/12/11/e063701.full |
| spellingShingle | Luckson Dullie Emily B Wroe Elizabeth L Dunbar Noel Kalanga Lawrence Nazimera Adarsh Shah Bright Mailosi Chiyembekezo Kachimanga Ryan K McBain Natalie Price Mahlet Gizaw Chantelle Boudreaux Liberty Neba Economic evaluation of integrated services for non-communicable diseases and HIV: costs and client outcomes in rural Malawi BMJ Open |
| title | Economic evaluation of integrated services for non-communicable diseases and HIV: costs and client outcomes in rural Malawi |
| title_full | Economic evaluation of integrated services for non-communicable diseases and HIV: costs and client outcomes in rural Malawi |
| title_fullStr | Economic evaluation of integrated services for non-communicable diseases and HIV: costs and client outcomes in rural Malawi |
| title_full_unstemmed | Economic evaluation of integrated services for non-communicable diseases and HIV: costs and client outcomes in rural Malawi |
| title_short | Economic evaluation of integrated services for non-communicable diseases and HIV: costs and client outcomes in rural Malawi |
| title_sort | economic evaluation of integrated services for non communicable diseases and hiv costs and client outcomes in rural malawi |
| url | https://bmjopen.bmj.com/content/12/11/e063701.full |
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