Potential impact of task-shifting on costs of antiretroviral therapy and physician supply in Uganda.
BACKGROUND
Lower-income countries face severe health worker shortages. Recent evidence suggests that this problem can be mitigated by task-shifting--delegation of aspects of health care to less specialized health workers. We estimated the potential impact of task-shifting on costs of antiretroviral therapy (ART) and physician supply in Uganda. The study was performed at the Infectious Diseases Institute (IDI) clinic, a large urban HIV clinic.


METHODS
We built an aggregate cost-minimization model from societal and Ministry of Health (MOH) perspectives. We compared physician-intensive follow-up (PF), the standard of care, with two methods of task-shifting: nurse-intensive follow-up (NF) and pharmacy-worker intensive follow-up (PWF). We estimated personnel and patient time use using a time-motion survey. We obtained unit costs from IDI and the literature. We estimated physician personnel impact by calculating full time equivalent (FTE) physicians saved. We made national projections for Uganda.


RESULTS
Annual mean costs of follow-up per patient were $59.88 (societal) and $31.68 (medical) for PF, $44.58 (societal) and $24.58 (medical) for NF and $18.66 (societal) and $10.5 (medical) for PWF. Annual national societal ART follow-up expenditure was $5.92 million using PF, $4.41 million using NF and $1.85 million using PWF, potentially saving $1.51 million annually by using NF and $4.07 million annually by using PWF instead of PF. Annual national MOH expenditure was $3.14 million for PF, $2.43 million for NF and $1.04 for PWF, potentially saving $0.70 million by using NF and $2.10 million by using PWF instead of PF. Projected national physician personnel needs were 108 FTE doctors to implement PF and 18 FTE doctors to implement NF or PWF. Task-shifting from PF to NF or PWF would potentially save 90 FTE physicians, 4.1% of the national physician workforce or 0.3 FTE physicians per 100,000 population.


CONCLUSIONS
Task-shifting results in substantial cost and physician personnel savings in ART follow-up in Uganda and can contribute to mitigating the heath worker crisis.
Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, WA, USA. babijo@u.washington.edu
Joseph B
JB
Babigumira
Barbara
B
Castelnuovo
Mohammed
M
Lamorde
Andrew
A
Kambugu
Andy
A
Stergachis
Philippa
P
Easterbrook
Louis P
LP
Garrison
D044966:Anti-Retroviral Agents / Q000191:economics* / Q000627:therapeutic use; D017046:Cost Savings / Q000379:methods*; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D009726:Nurses; D010043:Outcome and Process Assessment, Health Care; D010559:Personnel Management / Q000379:methods; D010595:Pharmacists; D010820:Physicians / Q000600:supply & distribution*; D010818:Practice Patterns, Physicians'; D013647:Task Performance and Analysis; D013997:Time Factors; D014454:Uganda; D014850:Waiting Lists; D016526:Workload / Q000706:statistics & numerical data
D044966:Anti-Retroviral Agents