Marseille 2007
| Abstract #626 - Establishing the Costs of Different Models of Antiretroviral Treatment Delivery Programs in Urban, Peri-Urban and Rural Settings in KwaZulu-Natal, South Africa | ||||
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Session: 49.1: Late Breakers (Parallel) on Wednesday @ 08.30-10.30 in HC Chaired by Bruno Spire, Kate Hankins Authors: Presenting Author: Ms Anokhi Parikh - Univ. Of KwaZulu Natal, South Africa |
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| Additional Authors: Ms Maria de los Angeles Cabrera Escobar, Dr Helga Holst, Dr Marionette Holmes, Dr Victor Fredlund, Dr Ric Marlink, Dr Janet Giddy , Dr Douglas Ross, Dr Umesh Lalloo, Ms Santhana Gengiah, | ||||
| Aim: The budgetary implications of a large and growing antiretroviral therapy (ART) programme in South Africa are immense as the government moves towards universal access. Thus, understanding the costs of delivering ART is of great policy importance. ART is being provided using different approaches in different settings, utilizing resources in distinct manners. For instance, some clinics use doctors intensively, while others rely on a more nurse and counselor centered approach. In light of this, the aim of the paper is to determine the costs of providing ART under three such models of care in three different settings in the province of KwaZulu Natal (KZN). | ||||
| Method / Issue: Three relatively well-established ART clinics were chosen to represent a range of approaches of ART provision across various settings - McCord hospital in Durban (urban), St. Marys hospital on the outskirts of Durban (peri-urban) and Mseleni hospital (rural). Differences in adherence support activities and the mix of human resources used on the program were identified as key differences between these sites. The cost analysis will focus on these differences. Cost data were collected from retrospective chart reviews of adult patients enrolled on ART between July 2004 and July 2006. A total of 2400 patient charts were reviewed, and each site's sample size was chosen to be proportional to the site's population size. Other cost data comes from reviews of hospital financial records (to establish capital and recurrent costs) and interviews with hospital finance and key clinical staff to establish working patterns and consultation times. Staff interviews and direct observation of consultation will be used to determine the time taken per consultation. Data for drug costs were obtained from Provincial tender prices; laboratory cost from the National Health Laboratory Service, salaries from KZN Department of Health We will estimate the resource utilization associated with treatment and care with each ART model at each site. We classify current operating costs into four categories - fixed capital, human capital, recurrent/maintenance costs, and incremental costs. The costing includes all costs, for example: transport is an important element in rural sites and will not be neglected. We will estimate the resource utilization associated with treatment of opportunistic infection and adverse events. Moreover, we will compare the drivers of cost across sites and check for statistical significance across sites. If such difference is to be found, multivariate regression analysis will be used to explore the drivers of cost between sites. | ||||
| Results / Comments: Data collection at all three sites is currently underway and will be completed in April 2007. We will present preliminary costing findings from the three sites. | ||||
| Discussion: We hypothesize that there is a statistically significant difference in resource utilization rates of HIV care resources and cost of ART delivery across sites. | ||||
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