title: Cost-Effectiveness Analysis of Hospitalization and Home-Based Care Strategies for People Living with HIV/AIDS: The Case of Zimbabwe.
abstract: The model of care of people living with HIV/AIDS (PLWHA) has shifted from hospital care to community home-based care (CHBC) because of shortage of space in hospitals and lack of resources. We evaluate the costs and benefits of home-based care and other HIV/AIDS intervention strategies in Zimbabwe, using an interdisciplinary approach which weaves together the techniques of an epidemic transmission model and economic evaluation concepts. The intervention strategies considered are voluntary counselling and testing (VCT), VCT combined with hospitalization (H), VCT combined with CHBC, and all the interventions implemented concurrently. The results of the study indicate that implementing all the strategies concurrently is the most cost-effective, a result which also agrees with the epidemiological model. Our results also show that the effectiveness of a strategy in the epidemiological model does not necessarily imply cost-effectiveness of the strategy and behaviour change, modelled by the parameters p and m, that accompanied the strategies, influencing both the cost-effectiveness of an intervention strategy and dynamics of the epidemic. This study shows that interdisciplinary collaborations can help in improving the accuracy of predictions of the course and cost of the epidemic and help policy makers in implementing the correct strategies.
authors.affiliation: Department of Applied Mathematics, National University of Science and Technology, P.O. Box AC 939, Ascot, Bulawayo, Zimbabwe.
authors.forename: Senelani D
authors.initials: SD
authors.lastname: Hove-Musekwa
authors.affiliation: Department of Mathematics, University of Stellenbosch, Private Bag X1, Matieland 7602, South Africa.
authors.forename: Farai
authors.identifier: 0000-0001-8607-7372
authors.initials: F
authors.lastname: Nyabadza
authors.affiliation: School of Mathematics Statistics and Computer Science, University of KwaZulu Natal, Durban Road, Pietermaritzburg 3201, South Africa.
authors.forename: Hermane
authors.initials: H
authors.lastname: Mambili-Mamboundou
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, Whatley Road, Bristol BS8 2PS, UK.
authors.forename: Christinah
authors.identifier: 0000-0003-4191-0361
authors.initials: C
authors.lastname: Chiyaka
authors.affiliation: London School of Tropical Hygiene and Medicine, Department of Global Health & Development, Keppel Street, Bloomsbury, London WC1E 7HT, UK.
authors.forename: Zindoga
authors.identifier: 0000-0002-8108-1441
authors.initials: Z
authors.lastname: Mukandavire