title: Cost-effectiveness of socioeconomic support as part of HIV care for the poor in an urban community-based antiretroviral program in Uganda.
abstract: BACKGROUND
  Socioeconomic support reduced nonretention in a community-based antiretroviral therapy (ART) program in Uganda. However, resource implications of expanding socioeconomic support are large, and cost-effectiveness analysis can inform budget priorities. We compared the incremental benefits and costs of providing education, food, or both forms of support (dual support) with existing ART services from a health care provider's perspective.
  
  
  METHODS
  Costs and outcome data were collected from a cohort of 2371 adult patients with HIV receiving education, food, or dual support from Reach Out Mbuya between 2004 and 2010. The primary outcome was averted loss to follow-up. The number of follow-up days was calculated for each patient along with accrued service and fixed program costs for the alternative forms of socioeconomic support in USD by standard costing methods. The socioeconomic support types were compared incrementally over the study period.
  
  
  RESULTS
  After 7 years, 762 (33%) of the patients were loss to follow-up with 42% of them receiving food. In the presence of providing ART, education support was less costly and more effective than the alternatives. The average unit cost for education, food, and dual support were $237, $538, and $776, respectively. The average total annual costs were $88,643 for education, $538,005 for food, and $103,045 for dual support.
  
  
  CONCLUSIONS
  Compared with food or dual support, investing in education of the children of ART patients is less costly and more effective in improving patient retention. Reach Out Mbuya should embrace this paradigm shift and channel its resources more efficiently and effectively by focusing on education support.
authors.affiliation: *Executive Directors Office, Reach Out Mbuya HIV/AIDS Initiative, Kampala, Uganda; †Center for Health Economics Research & Modeling Infectious Diseases (CHERMID, Vaccine & Infectious Disease Institute [Vaxinfectio]), University of Antwerp, Antwerp, Belgium; and ‡Institute of Tropical Medicine Antwerp, Antwerp, Belgium.
authors.forename: Alamo
authors.initials: A
authors.lastname: Stella-Talisuna
authors.forename: Joke
authors.initials: J
authors.lastname: Bilcke
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.forename: Philippe
authors.initials: P
authors.lastname: Beutels
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005378:Financial Support; D005523:Food Supply / Q000191:economics; D015658:HIV Infections / Q000188:drug therapy*; D006266:Health Education / Q000191:economics; D006801:Humans; D008297:Male; D012944:Social Support; D016896:Treatment Outcome; D014454:Uganda; D014505:Urban Population