title: The cost of providing comprehensive HIV treatment in PEPFAR-supported programs.
abstract: BACKGROUND
  PEPFAR, national governments, and other stakeholders are investing unprecedented resources to provide HIV treatment in developing countries. This study reports empirical data on costs and cost trends in a large sample of HIV treatment sites.
  
  
  METHODS
  In 2006-2007, we conducted cost analyses at 43 PEPFAR-supported outpatient clinics providing free comprehensive HIV treatment in Botswana, Ethiopia, Nigeria, Uganda, and Vietnam.
  
  
  METHODS
  We collected data on HIV treatment costs over consecutive 6-month periods starting from scale-up of dedicated HIV treatment services at each site. The study included all patients receiving HIV treatment and care at study sites [62,512 antiretroviral therapy (ART) and 44,394 pre-ART patients]. Outcomes were costs per patient and total program costs, subdivided by major cost categories.
  
  
  RESULTS
  Median annual economic costs were US$ 202 (2009 USD) for pre-ART patients and US$ 880 for ART patients. Excluding antiretrovirals, per patient ART costs were US$ 298. Care for newly initiated ART patients cost 15-20% more than for established patients. Per patient costs dropped rapidly as sites matured, with per patient ART costs dropping 46.8% between first and second 6-month periods after the beginning of scale-up, and an additional 29.5% the following year. PEPFAR provided 79.4% of funding for service delivery, and national governments provided 15.2%.
  
  
  CONCLUSIONS
  Treatment costs vary widely between sites, and high early costs drop rapidly as sites mature. Treatment costs vary between countries and respond to changes in antiretroviral regimen costs and the package of services. Whereas cost reductions may allow near-term program growth, programs need to weigh the trade-off between improving services for current patients and expanding coverage to new patients.
authors.affiliation: US Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: Nicolas A
authors.initials: NA
authors.lastname: Menzies
authors.forename: Andres A
authors.initials: AA
authors.lastname: Berruti
authors.forename: Richard
authors.initials: R
authors.lastname: Berzon
authors.forename: Scott
authors.initials: S
authors.lastname: Filler
authors.forename: Robert
authors.initials: R
authors.lastname: Ferris
authors.forename: Tedd V
authors.initials: TV
authors.lastname: Ellerbrock
authors.forename: John M
authors.initials: JM
authors.lastname: Blandford
mesh_terms: D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D001902:Botswana / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics* / Q000706:statistics & numerical data; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D015497:HIV-1; D006295:Health Resources / Q000191:economics* / Q000600:supply & distribution; D006801:Humans; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology; D014744:Vietnam / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents