Multi-country analysis of treatment costs for HIV/AIDS (MATCH): facility-level ART unit cost analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia.
BACKGROUND
Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia.


RESULTS
In 2010-2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2-8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77-95% alive and on treatment).


CONCLUSIONS
This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation.
HIV, TB and Health Financing, Clinton Health Access Initiative, Boston, Massachusetts, United States of America.
Elya
E
Tagar
HIV, TB and Health Financing, Clinton Health Access Initiative, Boston, Massachusetts, United States of America.
Maaya
M
Sundaram
HIV, TB and Health Financing, Clinton Health Access Initiative, Boston, Massachusetts, United States of America.
Kate
K
Condliffe
Planning, Monitoring, Evaluation and Research, National AIDS Commission, Lilongwe, Malawi.
Blackson
B
Matatiyo
Department for HIV and AIDS, Ministry of Health, Lilongwe, Malawi.
Frank
F
Chimbwandira
Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi.
Ben
B
Chilima
Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi.
Robert
R
Mwanamanga
National ART Program, Ministry of Health, Lusaka, Zambia.
Crispin
C
Moyo
Department of Economics, University of Zambia, Lusaka, Zambia.
Bona Mukosha
BM
Chitah
Planning, Monitoring and Evaluation Division, Ministry of Health, Kigali, Rwanda.
Jean Pierre
JP
Nyemazi
Planning, Monitoring and Evaluation Directorate, Federal HIV/AIDS Prevention and Control Office, Addis Ababa, Ethiopia.
Yibeltal
Y
Assefa
HIV/AIDS, TB and MCWH, National Department of Health, Pretoria, South Africa.
Yogan
Y
Pillay
HIV, TB and Health Financing, Clinton Health Access Initiative, Boston, Massachusetts, United States of America.
Sam
S
Mayer
HIV, TB and Health Financing, Clinton Health Access Initiative, Lilongwe, Malawi.
Lauren
L
Shear
HIV, TB and Health Financing, Clinton Health Access Initiative, Kigali, Rwanda.
Mary
M
Dain
HIV, TB and Health Financing, Clinton Health Access Initiative, Addis Ababa, Ethiopia.
Raphael
R
Hurley
HIV, TB and Health Financing, Clinton Health Access Initiative, Lusaka, Zambia.
Ritu
R
Kumar
HIV, TB and Health Financing, Clinton Health Access Initiative, Pretoria, South Africa.
Thomas
T
McCarthy
HIV, TB and Health Financing, Clinton Health Access Initiative, Boston, Massachusetts, United States of America.
Parul
P
Batra
HIV, TB and Health Financing, Clinton Health Access Initiative, Boston, Massachusetts, United States of America.
Dan
D
Gwinnell
HIV, TB and Health Financing, Clinton Health Access Initiative, Boston, Massachusetts, United States of America.
Samantha
S
Diamond
Center for Global Development, Washington, District of Columbia, United States of America.
Mead
M
Over
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000191:economics*; D044966:Anti-Retroviral Agents / Q000191:economics* / Q000627:therapeutic use; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology; D003140:Communicable Disease Control; D003141:Communicable Diseases / Q000191:economics; D003906:Developing Countries / Q000191:economics; D005002:Ethiopia; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics*; D017048:Health Care Costs; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000191:economics; D006801:Humans; D008295:Malawi; D018803:Models, Economic; D012432:Rwanda; D013019:South Africa; D016896:Treatment Outcome; D015024:Zambia
D044966:Anti-Retroviral Agents