PDF(Pubmed)
Abstract：
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 payer 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.
摘要：
抗逆转录病毒治疗（ART）在整个一生中都需要维持HIV感染者的病毒抑制。在南非,在农村地区，可靠获得抗逆转录病毒疗法的障碍仍然存在并被放大，在那里，艾滋病毒服务通常也更昂贵。最近的一项试点随机研究（交付健康研究）发现，家庭提供的ART笔芯，以较低的用户费用提供，在南非农村地区,有效克服了后勤障碍,改善了临床结局.在目前使用付款人视角的成本核算研究中，我们在交付健康研究中对家庭提供的ART进行了回顾性的基于活动的微观成本核算，并且在提供规模时（在农村环境中），并使用省级支出数据(涵盖农村和城市环境)与基于设施的成本进行比较。在试点分娩健康研究的背景下，每周三天平均每天分娩三次，家庭交付的ART成本（2022年美元）第一年为794美元，减去客户费用后，每位客户随后几年为714美元，相比之下，省级诊所护理的每位客户为167美元。我们估计，在农村地区，家庭提供的ART可以合理地扩大到每天12次，每周5天。当按比例交付时，家庭提供的ART在第一年的费用为267美元，在随后的几年中，每位客户的费用为183美元。当续杯时间从三个月增加到六个月和十二个月时，送货上门的平均成本进一步下降(从183美元增加到177美元，每位客户135美元，分别)。人员费用是家庭送餐补充的最大费用，而ART药物费用是诊所补充的最大费用。当按比例提供时，在农村地区，家庭提供的ART不仅为难以接触到的人群提供了临床益处，而且在成本上与省级护理标准相当。
