Similar costs and outcomes for differentiated service delivery models for HIV treatment in Uganda

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Abstract Background This study aimed to measure the total annual cost per patient and total cost per patient virally suppressed (defined as <1000 copies/ml) on antiretroviral therapy in Uganda in five differentiated service delivery models (DSDMs), including facility- and community-based models and the standard of care. Methods A cost/outcome study was undertaken from the perspective of the service provider, using retrospective patient record review of a cohort of patients over a two-year period, with bottom-up collection of patients’ resource utilization data, top-down collection of above-delivery level and delivery-level providers’ fixed operational costs, and local unit costs. Results Forty-seven DSDMs located at facilities or community-based points in four regions of Uganda were included in the study, with 653 adults on ART (>18 years old) enrolled in a DSDM. The study found that retention in care was 98% for the sample as a whole [96-100%], and viral suppression, 91% [86%-93%]. The mean cost to the provider (Ministry of Health or NGO implementers) was $152 per annum per patient treated, ranging from $141 to $166. Differences among the models’ costs were largely due to patients’ ARV regimens and proportions of patients on second line regimens. Service delivery costs, excluding ARVs, other medicines and laboratory tests, were modest, ranging from $9.66-16.43 per patient. Conclusion We conclude that differentiated ART service delivery in Uganda achieved excellent treatment outcomes at a cost similar to the standard of care. While large budgetary savings might not be immediately realized, the reallocation of “saved” staff time could improve health system efficiency as facilities and patients gain more experience with DSD models.

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