Resource Utilization and Costs of Care prior to ART Initiation for Pediatric Patients in Zambia.
Objective. We estimated time to initiation, outpatient resource use, and costs of outpatient care during the 6 months prior to ART initiation for HIV-infected pediatric patients in Zambia. Methods. We enrolled 1,102 children who initiated ART at <15 years of age between 2006 and 2011 at 5 study sites. Of these, 832 initiated ART ≤6 months after first presenting to care at the study sites. Data on time in care and resources utilized during the 6 months prior to ART initiation were extracted from patient medical records. Costs were estimated from the provider's perspective and are reported in 2011 USD. Results. For the patients who initiated ART ≤6 months after presenting to care, median age at presentation to care was 3.9 years; median CD4 percentage was 13%. Median time to ART initiation was 26 days. Patients made, on average, 2.38 clinic visits prior to ART initiation and received 0.81 CD4 tests, 0.74 full blood count tests, and 0.49 blood chemistry tests. The mean cost of pre-ART care was $20 per patient. Conclusions. Zambian pediatric patients initiating ART ≤6 months after presenting to care do so quickly, utilize fewer resources than mandated by national guidelines, and accrue low costs.
Zambia Center for Applied Health Research and Development, 10100 Lusaka, Zambia.
Hari S
HS
Iyer
Zambia Center for Applied Health Research and Development, 10100 Lusaka, Zambia ; Center for Global Health and Development, Boston University, Boston, MA 02118, USA.
Callie A
CA
Scott
Zambia Center for Applied Health Research and Development, 10100 Lusaka, Zambia.
Deophine
D
Lembela Bwalya
Center for Global Health and Development, Boston University, Boston, MA 02118, USA ; Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Clinical Medicine, School of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa.
Gesine
G
Meyer-Rath
Zambian Ministry of Health, 10100 Lusaka, Zambia.
Crispin
C
Moyo
Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA ; Centre for Infectious Disease Research in Zambia, 101000 Lusaka, Zambia.
Carolyn
C
Bolton Moore
Center for Global Health and Development, Boston University, Boston, MA 02118, USA ; Department of International Health, School of Public Health, Boston University, Boston, MA 02118, USA.
Bruce A
BA
Larson
Center for Global Health and Development, Boston University, Boston, MA 02118, USA ; Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Clinical Medicine, School of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa.
Sydney
0000-0002-6560-2964
S
Rosen