The cost of treating a person living with HIV
Few studies have examined total and per-patient cost of antiretroviral therapy (ART) services among patients who achieved viral suppression in sub-Saharan Africa from a programmatic perspective.
The average economic costs to treat established unstable HIV-patients (adults US$723), adolescents (US$800), pediatric patients (US$786) and infants (US$754) in Namibia, tends to be two to three times higher than those of established stable patients (adults – US$260), adolescents (US$439), pediatric patients (US$375) and infants (US$251).
A new report by the ministry of health and social services titled Determining the Cost of Providing HIV Care and Treatment, including the Achievement of Viral Suppression to patients at Antiretroviral Therapy Sites in Namibia provides data on per patient year cost of antiretroviral (ART) services among patients who achieved viral suppression, which is necessary for policymakers and program managers to budget appropriately and to implement programs that are more efficient and effective.
According to the report the average economic cost per patient-year in Namibia was found to be US$372 for patients on antiretroviral treatment (ART) or US$285 when the costs of ARV’s are excluded.
Laboratory costs were the largest cost input category for established patients, both stable and unstable, driven by the frequency of laboratory monitoring and follow-up tests.
When costs were dived across programmatic activities, laboratory services were found to represent the largest component, costing an average of US$168 per patient-year for ART patients and clinical care followed at US$75 per patient-year. Activities supporting direct service provision such as management, administration and monitoring and evaluation represented nontrivial additions to the total cost, with a combined cost of US$30 per patient-year.
The annual cost per virally suppressed patient and per patient averaged US$481 and US$379 respectively. Variations by age were US$449 and US$361 for adults, US$866 and US$629 for adolescents, US$760 and US$529 for children, and US$782 and US$771 for infants. Clinics with higher proportions of stable patients had lower per-patient costs.
Government sources which included support from the World Bank and the Global Fund to Fight HIV, Tuberculosis and Malaria were the largest source of funding, providing 85,3% of total funding. Pepfar funding accounted for 14,4% of total funding. Most resources from the ministry were devoted to laboratory services (51%), Pepfar funding was largely devoted to personnel (51%) and training costs (36%) and the Global Fund primarily funded ARV’s (61%) and the associated buffer stock (35%). Other local funds were primarily used for personnel (43%) and training (26%).
Few studies have examined total and per-patient cost of antiretroviral therapy (ART) services among patients who achieved viral suppression in sub-Saharan Africa from a programmatic perspective.
The study undertook retrospective cost analyses at nine clinics providing HIV treatment and care to estimate the annual costs of treatment for antiretroviral therapy (ART) patients borne by die government of Namibia, the American president’s Emergency Plan for AIDS Relief (Pepfar) and other local and international partners. Nine HIV treatment facilities were purposefully selected based on their geographic location, service delivery model and level in the Namibian health system to maximise the relevance for decision-making in Namibia.
Data were collected to show the differences between different patient types, as well as how costs were distributed across funding sources, input types and programmatic activities during October 1, 2017 and September 30, 2018. Per patient-year cost of HIV care and treatment were also estimated by viral suppression status.
The number of ART patients at the study sites ranged from 1 000 to 7 000 per year, with 87,2% of them being adults. The regimen with the most dispensed doses of the combination regimens was Tenofovir/Emtricitabine/Efavirenz. Full suppression rates varied from 62,2% to 90,7% among adults, 44,4% to 76,7% among adolescents, and 25% to 92,3% among children.
Across all clinics the number of clinics visited differed by patient type. New and unstable patients of all ages were seen more often (five to seven visits), while stable patients averaged two visits per year. Newly initiating adolescents, unstable pediatric and infant patients had the highest number of scheduled visits (seven visits per year). The staffing ration of registered nurses, was high for new (average of two registered nurses per 1 000 patients) and unstable patients (average of 3 registered nurses per 1 000 patients) as compared to stable patients (average of one registered nurse per 1 000 patients).
Group counselling was offered in three facilities, where stable patients attended four sessions per year and new and unstable patients attended 10 to 12 sessions per year. Of all the tests reported, stable patients received only viral load tests, one for adults and two for other age bands. Unstable patients received both viral load and CD4 tests, four tests per year regardless of age.
With a national HIV incidence of 3.49 per 1 000 persons, Namibia has a prevalence rate of 12,6% among adults aged 15 – 64 years. An estimated 200 000 people were living with HIV/Aids in 2017, making the country one of those in the world most affected by the disease.
Namibia’s national HIV care and treatment program has achieved antiretroviral therapy (ARV) coverage with optimal outcomes in recent years. In 2017 an estimated 84% of all people living with HIV (PLHIV) were on ART and 74% of all PLHIV were virally surpressed. Data from Unaids suggest that the 12 month ART retention rate is 84%. Data also shows that 77,4% (81,7% for females and 69,9% vor males) of people living with HIV/Aids between the ages of 15 to 64 years have achieved viral suppression, indicating that Namibia has made significant progress towards achieving the third of the 90-90-90 goals.
By September 2018, more than 250 health facilities were providing HIV care and treatment services in Namibia, with public facilities providing services to the majority of people living with HIV. Some faith-based facilities, which are all 100% government subsidised as well as private clinics also provide HIV care and treatment.
Source: Determining the Cost of Providing HIV Care and Treatment, including the Achievement of Viral Suppression to patients at Antiretroviral Therapy Sites in Namibia
A new report by the ministry of health and social services titled Determining the Cost of Providing HIV Care and Treatment, including the Achievement of Viral Suppression to patients at Antiretroviral Therapy Sites in Namibia provides data on per patient year cost of antiretroviral (ART) services among patients who achieved viral suppression, which is necessary for policymakers and program managers to budget appropriately and to implement programs that are more efficient and effective.
According to the report the average economic cost per patient-year in Namibia was found to be US$372 for patients on antiretroviral treatment (ART) or US$285 when the costs of ARV’s are excluded.
Laboratory costs were the largest cost input category for established patients, both stable and unstable, driven by the frequency of laboratory monitoring and follow-up tests.
When costs were dived across programmatic activities, laboratory services were found to represent the largest component, costing an average of US$168 per patient-year for ART patients and clinical care followed at US$75 per patient-year. Activities supporting direct service provision such as management, administration and monitoring and evaluation represented nontrivial additions to the total cost, with a combined cost of US$30 per patient-year.
The annual cost per virally suppressed patient and per patient averaged US$481 and US$379 respectively. Variations by age were US$449 and US$361 for adults, US$866 and US$629 for adolescents, US$760 and US$529 for children, and US$782 and US$771 for infants. Clinics with higher proportions of stable patients had lower per-patient costs.
Government sources which included support from the World Bank and the Global Fund to Fight HIV, Tuberculosis and Malaria were the largest source of funding, providing 85,3% of total funding. Pepfar funding accounted for 14,4% of total funding. Most resources from the ministry were devoted to laboratory services (51%), Pepfar funding was largely devoted to personnel (51%) and training costs (36%) and the Global Fund primarily funded ARV’s (61%) and the associated buffer stock (35%). Other local funds were primarily used for personnel (43%) and training (26%).
Few studies have examined total and per-patient cost of antiretroviral therapy (ART) services among patients who achieved viral suppression in sub-Saharan Africa from a programmatic perspective.
The study undertook retrospective cost analyses at nine clinics providing HIV treatment and care to estimate the annual costs of treatment for antiretroviral therapy (ART) patients borne by die government of Namibia, the American president’s Emergency Plan for AIDS Relief (Pepfar) and other local and international partners. Nine HIV treatment facilities were purposefully selected based on their geographic location, service delivery model and level in the Namibian health system to maximise the relevance for decision-making in Namibia.
Data were collected to show the differences between different patient types, as well as how costs were distributed across funding sources, input types and programmatic activities during October 1, 2017 and September 30, 2018. Per patient-year cost of HIV care and treatment were also estimated by viral suppression status.
The number of ART patients at the study sites ranged from 1 000 to 7 000 per year, with 87,2% of them being adults. The regimen with the most dispensed doses of the combination regimens was Tenofovir/Emtricitabine/Efavirenz. Full suppression rates varied from 62,2% to 90,7% among adults, 44,4% to 76,7% among adolescents, and 25% to 92,3% among children.
Across all clinics the number of clinics visited differed by patient type. New and unstable patients of all ages were seen more often (five to seven visits), while stable patients averaged two visits per year. Newly initiating adolescents, unstable pediatric and infant patients had the highest number of scheduled visits (seven visits per year). The staffing ration of registered nurses, was high for new (average of two registered nurses per 1 000 patients) and unstable patients (average of 3 registered nurses per 1 000 patients) as compared to stable patients (average of one registered nurse per 1 000 patients).
Group counselling was offered in three facilities, where stable patients attended four sessions per year and new and unstable patients attended 10 to 12 sessions per year. Of all the tests reported, stable patients received only viral load tests, one for adults and two for other age bands. Unstable patients received both viral load and CD4 tests, four tests per year regardless of age.
With a national HIV incidence of 3.49 per 1 000 persons, Namibia has a prevalence rate of 12,6% among adults aged 15 – 64 years. An estimated 200 000 people were living with HIV/Aids in 2017, making the country one of those in the world most affected by the disease.
Namibia’s national HIV care and treatment program has achieved antiretroviral therapy (ARV) coverage with optimal outcomes in recent years. In 2017 an estimated 84% of all people living with HIV (PLHIV) were on ART and 74% of all PLHIV were virally surpressed. Data from Unaids suggest that the 12 month ART retention rate is 84%. Data also shows that 77,4% (81,7% for females and 69,9% vor males) of people living with HIV/Aids between the ages of 15 to 64 years have achieved viral suppression, indicating that Namibia has made significant progress towards achieving the third of the 90-90-90 goals.
By September 2018, more than 250 health facilities were providing HIV care and treatment services in Namibia, with public facilities providing services to the majority of people living with HIV. Some faith-based facilities, which are all 100% government subsidised as well as private clinics also provide HIV care and treatment.
Source: Determining the Cost of Providing HIV Care and Treatment, including the Achievement of Viral Suppression to patients at Antiretroviral Therapy Sites in Namibia
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