title: ART treatment costs and retention in care in Kenya: a cohort study in three rural outpatient clinics.
abstract: BACKGROUND
  After almost 10 years of PEPFAR funding for antiretroviral therapy (ART) treatment programmes in Kenya, little is known about the cost of care provided to HIV-positive patients receiving ART. With some 430,000 ART patients, understanding and managing costs is essential to treatment programme sustainability.
  
  
  METHODS
  Using patient-level data from medical records (n=120/site), we estimated the cost of providing ART at three treatment sites in the Rift Valley Province of Kenya (a clinic at a government hospital, a hospital run by a large agricultural company and a mission hospital). Costs included ARV and non-ARV drugs, laboratory tests, salaries to personnel providing patient care, and infrastructure and other fixed costs. We report the average cost per patient during the first 12 months after ART initiation, stratified by site, and the average cost per patient achieving the primary outcome, retention in care 12 months after treatment initiation.
  
  
  RESULTS
  The cost per patient initiated on ART was $206, $252 and $213 at Sites 1, 2 and 3, respectively. The proportion of patients remaining in care at 12 months was similar across all sites (0.82, 0.80 and 0.84). Average costs for the subset of patients who remained in care at 12 months was also similar (Site 1, $229; Site 2, $287; Site 3, $237). Patients not retained in care cost substantially less (Site 1, $104; Site 2, $113; Site 3, $88). For the subset of patients who remained in care at 12 months, ART medications accounted for 51%, 44% and 50% of the costs, with the remaining costs split between non-ART medications (15%, 11%, 10%), laboratory tests (14%, 15%, 15%), salaries to personnel providing patient care (9%, 11%, 12%) and fixed costs (11%, 18%, 13%).
  
  
  CONCLUSIONS
  At all three sites, 12-month retention in care compared favourably to retention rates reported in the literature from other low-income African countries. The cost of providing treatment was very low, averaging $224 in the first year, less than $20/month. The cost of antiretroviral medications, roughly $120 per year, accounted for approximately half of the total costs per patient retained in care after 12 months.
authors.affiliation: Center for Global Health and Development, Boston University, Boston, MA, USA. blarson@bu.edu
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Larson
authors.forename: Margaret
authors.initials: M
authors.lastname: Bii
authors.forename: Sarah
authors.initials: S
authors.lastname: Henly-Thomas
authors.forename: Kelly
authors.initials: K
authors.lastname: McCoy
authors.forename: Fredrick
authors.initials: F
authors.lastname: Sawe
authors.forename: Douglas
authors.initials: D
authors.lastname: Shaffer
authors.forename: Sydney
authors.initials: S
authors.lastname: Rosen
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000191:economics; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007630:Kenya; D008297:Male; D012424:Rural Population; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents