PMID- 28692543
DCOM- 20180508
LR  - 20180523
IS  - 1473-5571 (Electronic)
IS  - 0269-9370 (Linking)
VI  - 31
IP  - 14
DP  - 2017 Sep 10
TI  - Impact and economic evaluation of a novel HIV service delivery model in rural
PG  - 1999-2006
LID - 10.1097/QAD.0000000000001578 [doi]
AB  - OBJECTIVE: We performed an impact and cost-effectiveness analysis of a novel HIV 
      service delivery model in a high prevalence, remote district of Malawi with a
      population of 143 800 people. DESIGN: A population-based retrospective analysis
      of 1-year survival rates among newly enrolled HIV-positive patients at 682 health
      facilities throughout Malawi, comparing facilities implementing the service
      delivery model (n = 13) and those implementing care-as-usual (n = 669). METHODS: 
      Through district-level health surveillance data, we evaluated 1-year survival
      rates among HIV patients newly enrolled between July 2013 and June 2014 -
      representing 129 938 patients in care across 682 health facilities - using a
      multilevel modeling framework. The model, focused on social determinants of
      health, was implemented throughout Neno District at 13 facilities and compared
      with facilities in all other districts. Activity-based costing was used to
      annualize financial and economic costs from a societal perspective. Incremental
      cost-effectiveness ratios were expressed as quality-adjusted life-years gained.
      RESULTS: The national average 1-year survival rate for newly enrolled
      antiretroviral therapy clients was 78.9%: this rate was 87.9% in Neno District,
      compared with 78.8% across all other districts in Malawi (P < 0.001; 95%
      confidence interval: 0.079-0.104). The economic cost of receiving care in Neno
      district (n = 6541 patients) was $317/patient/year, compared with an estimated
      $219/patient in other districts. This translated to $906 per quality-adjusted
      life-year gained. CONCLUSION: Neno District's comprehensive model of care,
      featuring a strong focus on the community, is $98 more expensive per capita per
      annum but demonstrates superior 1-year survival rates, despite its remote
      location. Moreover, it should be considered cost-effective by traditional
      international standards.
FAU - McBain, Ryan K
AU  - McBain RK
AD  - aPartners In Health bDivision of Global Health Equity, Brigham & Women's Hospital
      cBoston Consulting Group, Boston, Massachusetts, USA dPartners In Health - Malawi
      eMalawi Ministry of Health, Neno fMalawi Ministry of Health, Lilongwe, Malawi
      gDepartment of Global Health and Social Medicine, Harvard Medical School, Boston,
      Massachusetts, USA.
FAU - Petersen, Elizabeth
AU  - Petersen E
FAU - Tophof, Nora
AU  - Tophof N
FAU - Dunbar, Elizabeth L
AU  - Dunbar EL
FAU - Kalanga, Noel
AU  - Kalanga N
FAU - Nazimera, Lawrence
AU  - Nazimera L
FAU - Mganga, Andrew
AU  - Mganga A
FAU - Dullie, Luckson
AU  - Dullie L
FAU - Mukherjee, Joia
AU  - Mukherjee J
FAU - Wroe, Emily B
AU  - Wroe EB
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - England
JT  - AIDS (London, England)
JID - 8710219
SB  - IM
SB  - X
MH  - Cost-Benefit Analysis
MH  - *Disease Management
MH  - Female
MH  - HIV Infections/*diagnosis/*drug therapy
MH  - Health Services Administration/*economics
MH  - *Health Services Research
MH  - Humans
MH  - Malawi
MH  - Male
MH  - Pregnancy
MH  - Retrospective Studies
MH  - Rural Population
MH  - Survival Analysis
EDAT- 2017/07/12 06:00
MHDA- 2018/05/09 06:00
CRDT- 2017/07/11 06:00
PHST- 2017/07/12 06:00 [pubmed]
PHST- 2018/05/09 06:00 [medline]
PHST- 2017/07/11 06:00 [entrez]
AID - 10.1097/QAD.0000000000001578 [doi]
PST - ppublish
SO  - AIDS. 2017 Sep 10;31(14):1999-2006. doi: 10.1097/QAD.0000000000001578.