title: Annual cost of antiretroviral therapy among three service delivery models in Uganda.
abstract: In response to the increasing burden of HIV, the Ugandan government has employed different service delivery models since 2004 that aim to reduce costs and remove barriers to accessing HIV care. These models include community-based approaches to delivering antiretroviral therapy (ART) and delegating tasks to lower-level health workers. This study aimed to provide data on annual ART cost per client among three different service delivery models in Uganda.
  
  
  
  Costing data for the entire year 2012 were retrospectively collected as part of a larger task-shifting study conducted in three organizations in Uganda: Kitovu Mobile (KM), the AIDS Support Organisation (TASO) and Uganda Cares (UC). A standard cost data capture tool was developed and used to retrospectively collect cost information regarding antiretroviral (ARV) drugs and non-ARV drugs, ART-related lab tests, personnel and administrative costs. A random sample of four TASO centres (out of 11), four UC clinics (out of 29) and all KM outreach units were selected for the study.
  
  
  
  Cost varied across sites within each organization as well as across the three organizations. In addition, the number of annual ART visits was more frequent in rural areas and through KM (the community distribution model), which played a major part in the overall annual ART cost. The annual cost per client (in USD) was $404 for KM, $332 for TASO and $257 for UC. These estimates were lower than previous analyses in Uganda or the region compared to data from 2001 to 2009, but comparable with recent estimates using data from 2010 to 2013. ARVs accounted for the majority of the total cost, followed by personnel and operational costs.
  
  
  
  The study provides updated data on annual cost per ART visit for three service delivery models in Uganda. These data will be vital for in-country budgetary efforts to ensure that universal access to ART, as called for in the 2015 World Health Organization (WHO) guidelines, is achievable. The lower annual ART cost found in this study indicates that we may be able to treat all people with HIV as laid out in the 2015 WHO guidelines. The variation of costs across sites and the three models indicates the potential for efficiency gains.
authors.affiliation: Population Council, Washington, DC, USA; lung.vu@gmail.com.
authors.forename: Lung
authors.initials: L
authors.lastname: Vu
authors.affiliation: Kitovu Mobile AIDS Organisation, Masaka, Uganda.
authors.forename: Samuel
authors.initials: S
authors.lastname: Waliggo
authors.affiliation: Population Council, Washington, DC, USA.
authors.forename: Brady
authors.initials: B
authors.lastname: Zieman
authors.affiliation: Population Council, Washington, DC, USA.
authors.forename: Nrupa
authors.initials: N
authors.lastname: Jani
authors.affiliation: Uganda Cares, Kampala, Uganda.
authors.forename: Lydia
authors.initials: L
authors.lastname: Buzaalirwa
authors.affiliation: The AIDS Support Organisation, Kampala, Uganda.
authors.forename: Stephen
authors.initials: S
authors.lastname: Okoboi
authors.affiliation: Population Council, Nairobi, Kenya.
authors.forename: Jerry
authors.initials: J
authors.lastname: Okal
authors.affiliation: US Agency for International Development, Washington, DC, USA.
authors.forename: Nagesh N
authors.initials: NN
authors.lastname: Borse
authors.affiliation: Population Council, Washington, DC, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kalibala
mesh_terms: D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D003695:Delivery of Health Care / Q000191:economics*; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics*; D006282:Health Personnel; D006801:Humans; D018803:Models, Economic; D014454:Uganda; D014944:World Health Organization
chemical_list: D019380:Anti-HIV Agents
keywords: ART; Uganda; community-based ART; cost; efficiency; task-shifting