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Integrating tuberculosis and HIV services for people living with HIV: costs of the Zambian ProTEST Initiative.

Terris-Prestholt F, Kumaranayake L, Ginwalla R, Ayles H, Kayawe I, Hillery M, Godfrey-Faussett P - Cost Eff Resour Alloc (2008)

Bottom Line: The cost per HBC patient was $149, and per hospice bednight was $24.This study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive.The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.

View Article: PubMed Central - HTML - PubMed

Affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Fern.Terris-Prestholt@lshtm.ac.uk

ABSTRACT

Background: In the face of the dual TB/HIV epidemic, the ProTEST Initiative was one of the first to demonstrate the feasibility of providing collaborative TB/HIV care for people living with HIV (PLWH) in poor settings. The ProTEST Initiative facilitated collaboration between service providers. Voluntary counselling and testing (VCT) acted as the entry point for services including TB screening and preventive therapy, clinical treatment for HIV-related disease, and home-based care (HBC), and a hospice. This paper estimates the costs of the ProTEST Initiative in two sites in urban Zambia, prior to the introduction of anti-retroviral therapy.

Methods: Annual financial and economic providers costs and output measures were collected in 2000-2001. Estimates are made of total costs for each component and average costs per: person reached by ProTEST; VCT pre-test counselled, tested and completed; isoniazid preventive therapy started and completed; clinic visit; HBC patient; and hospice admission and bednight.

Results: Annual core ProTEST costs were (in 2007 US dollars) $84,213 in Chawama and $31,053 in Matero. The cost of coordination was 4%-5% of total site costs ($1-$6 per person reached). The largest cost component in Chawama was voluntary counselling and testing (56%) and the clinic in Matero (50%), where VCT clients had higher HIV-prevalences and more advanced HIV. Average costs were lower for all components in the larger site. The cost per HBC patient was $149, and per hospice bednight was $24.

Conclusion: This study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive. The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.

No MeSH data available.


Related in: MedlinePlus

Contribution of core components to site total costs.
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Figure 2: Contribution of core components to site total costs.

Mentions: Component costs are presented by input in Tables 1, 2, 3, and their contribution to total annual costs in Figure 2. The total annual economic cost of ProTEST core components was $84,213 in Chawama and $32,347 in Matero. The annual economic cost of ProTEST co-ordination was $1,446 in Matero and $4,225 in Chawama, 4%–5% of site costs in both. Matero start-up costs were treated as capital and were annualised using a 3% discount rate, this came to a cost of $899 per year, which would increase ProTEST co-ordination costs to 8% of site costs.


Integrating tuberculosis and HIV services for people living with HIV: costs of the Zambian ProTEST Initiative.

Terris-Prestholt F, Kumaranayake L, Ginwalla R, Ayles H, Kayawe I, Hillery M, Godfrey-Faussett P - Cost Eff Resour Alloc (2008)

Contribution of core components to site total costs.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2266707&req=5

Figure 2: Contribution of core components to site total costs.
Mentions: Component costs are presented by input in Tables 1, 2, 3, and their contribution to total annual costs in Figure 2. The total annual economic cost of ProTEST core components was $84,213 in Chawama and $32,347 in Matero. The annual economic cost of ProTEST co-ordination was $1,446 in Matero and $4,225 in Chawama, 4%–5% of site costs in both. Matero start-up costs were treated as capital and were annualised using a 3% discount rate, this came to a cost of $899 per year, which would increase ProTEST co-ordination costs to 8% of site costs.

Bottom Line: The cost per HBC patient was $149, and per hospice bednight was $24.This study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive.The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.

View Article: PubMed Central - HTML - PubMed

Affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Fern.Terris-Prestholt@lshtm.ac.uk

ABSTRACT

Background: In the face of the dual TB/HIV epidemic, the ProTEST Initiative was one of the first to demonstrate the feasibility of providing collaborative TB/HIV care for people living with HIV (PLWH) in poor settings. The ProTEST Initiative facilitated collaboration between service providers. Voluntary counselling and testing (VCT) acted as the entry point for services including TB screening and preventive therapy, clinical treatment for HIV-related disease, and home-based care (HBC), and a hospice. This paper estimates the costs of the ProTEST Initiative in two sites in urban Zambia, prior to the introduction of anti-retroviral therapy.

Methods: Annual financial and economic providers costs and output measures were collected in 2000-2001. Estimates are made of total costs for each component and average costs per: person reached by ProTEST; VCT pre-test counselled, tested and completed; isoniazid preventive therapy started and completed; clinic visit; HBC patient; and hospice admission and bednight.

Results: Annual core ProTEST costs were (in 2007 US dollars) $84,213 in Chawama and $31,053 in Matero. The cost of coordination was 4%-5% of total site costs ($1-$6 per person reached). The largest cost component in Chawama was voluntary counselling and testing (56%) and the clinic in Matero (50%), where VCT clients had higher HIV-prevalences and more advanced HIV. Average costs were lower for all components in the larger site. The cost per HBC patient was $149, and per hospice bednight was $24.

Conclusion: This study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive. The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.

No MeSH data available.


Related in: MedlinePlus