title: Estimating the cost of increasing retention in care for HIV-infected patients: results of the CDC/HRSA retention in care trial.
abstract: BACKGROUND
  Retaining HIV patients in medical care promotes access to antiretroviral therapy, viral load suppression, and reduced HIV transmission to partners. We estimate the programmatic costs of a US multisite randomized controlled trial of an intervention to retain HIV patients in care.
  
  
  METHODS
  Six academically affiliated HIV clinics randomized patients to intervention (enhanced personal contact with patients across time coupled with basic HIV education) and control [standard of care (SOC)] arms. Retention in care was defined as 4-month visit constancy, that is, at least 1 primary care visit in each 4-month interval over a 12-month period. We used microcosting methods to collect unit costs and measure the quantity of resources used to implement the intervention in each clinic. All fixed and variable labor and nonlabor costs of the intervention were included.
  
  
  RESULTS
  Visit constancy was achieved by 45.7% (280/613) of patients in the SOC arm and by 55.8% (343/615) of patients in the intervention arm, representing an increase of 63 patients (relative improvement 22.1%; 95% confidence interval: 9% to 36%; P < 0.01). The total annual cost of the intervention at the 6 clinics was $241,565, the average cost per patient was $393, and the estimated cost per additional patient retained in care beyond SOC was $3834.
  
  
  CONCLUSIONS
  Our analyses showed that a retention in care intervention consisting of enhanced personal contact coupled with basic HIV education may be delivered at fairly low cost. These results provide useful information for guiding decisions about planning or scaling-up retention in care interventions for HIV-infected patients.
authors.affiliation: *Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA; †HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD; ‡Department of Medicine, Baylor College of Medicine, Houston, TX; §Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; ‖Department of Medicine, Boston University School of Medicine, Boston, MA; ¶Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; #Division of Infectious Diseases, Miller School of Medicine, University of Miami, Miami, FL; **Department of Community Health Sciences, SUNY Downstate Medical Center School of Public Health, Brooklyn, NY; and ††Division of Infectious Diseases, Department of Medicine, University of Alabama-Birmingham, Birmingham, AL.
authors.forename: Ram K
authors.initials: RK
authors.lastname: Shrestha
authors.forename: Lytt
authors.initials: L
authors.lastname: Gardner
authors.forename: Gary
authors.initials: G
authors.lastname: Marks
authors.forename: Jason
authors.initials: J
authors.lastname: Craw
authors.forename: Faye
authors.initials: F
authors.lastname: Malitz
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Giordano
authors.forename: Meg
authors.initials: M
authors.lastname: Sullivan
authors.forename: Jeanne
authors.initials: J
authors.lastname: Keruly
authors.forename: Allan
authors.initials: A
authors.lastname: Rodriguez
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Wilson
authors.forename: Michael
authors.initials: M
authors.lastname: Mugavero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000191:economics / Q000379:methods; D003695:Delivery of Health Care / Q000191:economics* / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D014481:United States; D055815:Young Adult; D016903:Drug Monitoring