title: Cost-effectiveness of implementing the chronic care model for HIV care in Uganda.
abstract: OBJECTIVE
  The chronic care model (CCM) is an integrated, population-based approach for treating those with chronic diseases that involves patient self-management, delivery system design and decision support for clinicians to ensure evidence-based care. We sought to determine effectiveness and cost-effectiveness of implementing the CCM for HIV care in Uganda.
  
  
  METHODS
  This controlled, pre/post-intervention study used difference-in-differences analysis to evaluate effectiveness of the CCM to improve patient adherence to antiretroviral therapy (ART) and CD4 counts.
  
  
  METHODS
  One district hospital and two smaller facilities each in one intervention and one control district in Uganda.
  
  
  METHODS
  About 46 randomly sampled patients receiving HIV services at three control sites and 56 patients from three intervention sites.
  
  
  METHODS
  Two group training sessions and monthly coaching visits from improvement experts over 1 year, implementing the CCM.
  
  
  METHODS
  Patient adherence to ART prescriptions (pill counts) and CD4 counts were measured at baseline and en dline.
  
  
  RESULTS
  The odds of increased CD4 in the intervention group was 3.2 times higher than controls (P = 0.022). Clinician-reported ART adherence was 60% (P = 0.001) higher in the intervention group. The intervention cost $11 740 and served 7016 patients ($1.67 per patient). Incremental cost-effectiveness ratios of the intervention compared to business-as-usual was $6.90 per additional patient with improved CD4 and $3.40 per additional ART patient with stable or improved adherence.
  
  
  CONCLUSIONS
  For modest expenditure, it is possible to improve indicators of HIV care quality using the CCM. We recommended implementing the CCM in Uganda; it may be applicable in similar settings in other countries.
authors.affiliation: R&E director, University Research Co., LLC.|Department of International Health Associate, Johns Hopkins School of Public Health.
authors.forename: Edward I
authors.initials: EI
authors.lastname: Broughton
authors.affiliation: Senior Quality Improvement Advisor, University Research Co., LLC.
authors.forename: Martin
authors.initials: M
authors.lastname: Muhire
authors.affiliation: Deputy COP, University Research Co., LLC.
authors.forename: Esther
authors.initials: E
authors.lastname: Karamagi
authors.affiliation: Senior Quality Improvement Advisor, University Research Co., LLC.
authors.forename: Herbert
authors.initials: H
authors.lastname: Kisamba
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000628:therapy; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010349:Patient Compliance; D019984:Quality Indicators, Health Care; D012648:Self Care; D014454:Uganda
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV; chronic care model; cost-effectiveness; self-management