title: Superior outcomes and lower outpatient costs with scale-up of antiretroviral therapy at the GHESKIO clinic in Port-au-Prince, Haiti.
abstract: BACKGROUND
  Treatment protocols and prices of antiretroviral therapy (ART) have changed over time. Yet, limited data exist to evaluate the impact of these changes on patient outcomes and treatment costs in resource-poor settings.
  
  
  METHODS
  We compared patient-level data on outcomes, utilization, and cost for the first 2 years of ART for a cohort of adult patients initiating ART in 2003-2004 and a cohort initiating ART in 2006-2008 at the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections clinic (GHESKIO) in Port-au-Prince, Haiti. Costs were measured from the health center perspective. Multivariate analyses were conducted to account for the potential impact of differences in disease severity at baseline.
  
  
  RESULTS
  With the exclusion of patients who transferred care, 92% (167/181) of patients in the 2006-2008 cohort and 75% (150/200) in the 2003-2004 cohort were alive and in care at the end of the study period. The mean cost per patient for the 2-year study period was US$723 for the 2006-2008 cohort vs. US$1191 for the 2003-2004 cohort, a cost difference of US$468 (P < 0.0001). The mean cost per patient alive and in care at the end of the 2-year study period was US$744 for the 2006-2008 cohort vs. US$1489 for the 2003-2004 cohort (P < 0.0001).
  
  
  CONCLUSIONS
  HIV treatment outcomes in Haiti have improved over time while treatment costs declined by over 50% per patient alive and in care at the end of the 2-year study period. The major drivers in the reduction of treatment costs were the lower price of ART, lower costs for laboratory testing, and lower overhead costs.
authors.affiliation: *Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti; †Analysis Group, Boston, MA; ‡Massachusetts Institute of Technology, Cambridge, MA; §London School of Hygiene and Tropical Medicine, London, United Kingdom; ‖Abt Associates, Cambridge, MA; ¶Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA; #Weill Cornell Medical College, New York, NY; and **Center for Global Health, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, NY.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Riviere
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Faust
authors.forename: Thane
authors.initials: T
authors.lastname: Miller
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Beck
authors.forename: Elaine
authors.initials: E
authors.lastname: Baruwa
authors.forename: Patrice
authors.initials: P
authors.lastname: Severe
authors.forename: Karine
authors.initials: K
authors.lastname: Severe
authors.forename: Claudia Thomas
authors.initials: CT
authors.lastname: Riché
authors.forename: Rachelle
authors.initials: R
authors.lastname: Cassagnol
authors.forename: Sidney
authors.initials: S
authors.lastname: Atwood
authors.forename: Morgan
authors.initials: M
authors.lastname: Esperance
authors.forename: Lauren
authors.initials: L
authors.lastname: Webster
authors.forename: Pierre
authors.initials: P
authors.lastname: Cremieux
authors.forename: Jean W
authors.initials: JW
authors.lastname: Pape
authors.forename: Serena P
authors.initials: SP
authors.lastname: Koenig
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000191:economics*; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006205:Haiti / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents