title: The costs of providing antiretroviral therapy services to HIV-infected individuals presenting with advanced HIV disease at public health centres in Dar es Salaam, Tanzania: Findings from a randomised trial evaluating different health care strategies.
abstract: BACKGROUND
  Understanding the costs associated with health care delivery strategies is essential for planning. There are few data on health service resources used by patients and their associated costs within antiretroviral (ART) programmes in Africa.
  
  
  METHODS
  The study was nested within a large trial, which evaluated screening for cryptococcal meningitis and tuberculosis and a short initial period of home-based adherence support for patients initiating ART with advanced HIV disease in Tanzania and Zambia. The economic evaluation was done in Tanzania alone. We estimated costs of providing routine ART services from the health service provider's perspective using a micro-costing approach. Incremental costs for the different novel components of service delivery were also estimated. All costs were converted into US dollars (US$) and based on 2012 prices.
  
  
  RESULTS
  Of 870 individuals enrolled in Tanzania, 434 were enrolled in the intervention arm and 436 in the standard care/control arm. Overall, the median (IQR) age and CD4 cell count at enrolment were 38 [31, 44] years and 52 [20, 89] cells/mm3, respectively. The mean per patient costs over the first three months and over a one year period of follow up following ART initiation in the standard care arm were US$ 107 (95%CI 101-112) and US$ 265 (95%CI 254-275) respectively. ART drugs, clinic visits and hospital admission constituted 50%, 19%, and 19% of the total cost per patient year, while diagnostic tests and non-ART drugs (co-trimoxazole) accounted for 10% and 2% of total per patient year costs. The incremental costs of the intervention to the health service over the first three months was US$ 59 (p<0.001; 95%CI 52-67) and over a one year period was US$ 67(p<0.001; 95%CI 50-83). This is equivalent to an increase of 55% (95%CI 51%-59%) in the mean cost of care over the first three months, and 25% (95%CI 20%-30%) increase over one year of follow up.
authors.affiliation: Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania.|Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Godfather Dickson
authors.initials: GD
authors.lastname: Kimaro
authors.affiliation: Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania.
authors.forename: Sayoki
authors.initials: S
authors.lastname: Mfinanga
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Victoria
authors.initials: V
authors.lastname: Simms
authors.affiliation: Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania.
authors.forename: Sokoine
authors.initials: S
authors.lastname: Kivuyo
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Christian
authors.initials: C
authors.lastname: Bottomley
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Hawkins
authors.affiliation: Institute for Infection and Immunity, St Georges University of London, London, United Kingdom.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Harrison
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Shabbar
authors.initials: S
authors.lastname: Jaffar
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Lorna
authors.initials: L
authors.lastname: Guinness
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D018791:CD4 Lymphocyte Count; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000821:virology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D000072440:Public Health Systems Research; D013636:Tanzania; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000191:economics / Q000627:therapeutic use; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D015024:Zambia
chemical_list: D019380:Anti-HIV Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination