TITLE

Treatment outcomes and cost-effectiveness of shifting management of stable ART patients to nurses in South Africa: an observational cohort

AUTHOR(S)
Long, Lawrence; Brennan, Alana; Fox, Matthew P.; Ndibongo, Buyiswa; Jaffray, Imogen; Sanne, Ian; Rosen, Sydney
PUB. DATE
July 2011
SOURCE
PLoS Medicine;Jul2011, Vol. 8 Issue 7, p1
SOURCE TYPE
Academic Journal
DOC. TYPE
journal article
ABSTRACT
Background: To address human resource and infrastructure shortages, resource-constrained countries are being encouraged to shift HIV care to lesser trained care providers and lower level health care facilities. This study evaluated the cost-effectiveness of down-referring stable antiretroviral therapy (ART) patients from a doctor-managed, hospital-based ART clinic to a nurse-managed primary health care facility in Johannesburg, South Africa.Methods and Findings: Criteria for down-referral were stable ART (≥11 mo), undetectable viral load within the previous 10 mo, CD4>200 cells/mm(3), <5% weight loss over the last three visits, and no opportunistic infections. All patients down-referred from the treatment-initiation site to the down-referral site between 1 February 2008 and 1 January 2009 were compared to a matched sample of patients eligible for down-referral but not down-referred. Outcomes were assigned based on vital and health status 12 mo after down-referral eligibility and the average cost per outcome estimated from patient medical record data. The down-referral site (n = 712) experienced less death and loss to follow up than the treatment-initiation site (n = 2,136) (1.7% versus 6.2%, relative risk = 0.27, 95% CI 0.15-0.49). The average cost per patient-year for those in care and responding at 12 mo was US$492 for down-referred patients and US$551 for patients remaining at the treatment-initiation site (p<0.0001), a savings of 11%. Down-referral was the cost-effective strategy for eligible patients.Conclusions: Twelve-month outcomes of stable ART patients who are down-referred to a primary health clinic are as good as, or better than, the outcomes of similar patients who are maintained at a hospital-based ART clinic. The cost of treatment with down-referral is lower across all outcomes and would save 11% for patients who remain in care and respond to treatment. These results suggest that this strategy would increase treatment capacity and conserve resources without compromising patient outcomes.
ACCESSION #
64288017

 

Related Articles

  • Cost-effectiveness of highly active antiretroviral therapy in South Africa. Badri, Motasim; Maartens, Gary; Mandalia, Sundhiya; Bekker, Linda-Gail; Penrod, John R.; Platt, Robert W.; Wood, Robin; Beck, Eduard J. // PLoS Medicine;Jan2006, Vol. 3 Issue 1, pe4 

    Background: Little information exists on the impact of highly active antiretroviral therapy (HAART) on health-care provision in South Africa despite increasing scale-up of access to HAART and gradual reduction in HAART prices.Methods and Findings: Use and cost of...

  • Food insecurity is associated with poor virologic response among HIV-infected patients receiving antiretroviral medications. Wang, Emily A.; McGinnis, Kathleen A.; Fiellin, David A.; Goulet, Joseph L.; Bryant, Kendall; Gibert, Cynthia L.; Leaf, David A.; Mattocks, Kristin; Sullivan, Lynn E.; Vogenthaler, Nicholas; Justice, Amy C.; VACS Project Team // JGIM: Journal of General Internal Medicine;Sep2011, Vol. 26 Issue 9, p1012 

    Background and Objective: Food insecurity negatively impacts HIV disease outcomes in international settings. No large scale U.S. studies have investigated the association between food insecurity and severity of HIV disease or the mechanism of this possible association. The objective...

  • Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe. Schomaker, Michael; Leroy, Valeriane; Wolfs, Tom; Technau, Karl-Günter; Renner, Lorna; Judd, Ali; Sawry, Shobna; Amorissani-Folquet, Madeleine; Noguera-Julian, Antoni; Tanser, Frank; Eboua, François; Navarro, Maria Luisa; Chimbetete, Cleophas; Amani-Bosse, Clarisse; Warszawski, Josiane; Phiri, Sam; N'Gbeche, Sylvie; Cox, Vivian; Koueta, Fla; Giddy, Janet // International Journal of Epidemiology;Apr2017, Vol. 46 Issue 2, p453 

    Background: There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents.Methods: A total of 20 576 antiretroviral treatment (ART)-naïve patients, aged 1-16 years at enrolment, from 19 cohorts in...

  • Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? Beach, Mary Catherine; Keruly, Jeanne; Moore, Richard D. // JGIM: Journal of General Internal Medicine;Jun2006, Vol. 21 Issue 6, p661 

    PURPOSE: Patient-centeredness, originally defined as understanding each patient as a unique person, is widely considered the standard for high-quality interpersonal care. The purpose of our study was to examine the association between patient perception of being ‘known as a person’...

  • Dyslipidaemia in HIV-infected patients: association with adherence to potent antiretroviral therapy. Vergis, Emanuel N.; Paterson, David L.; Wagener, Marilyn M.; Swindells, Susan; Singh, Nina; Vergis, E N; Paterson, D L; Wagener, M M; Swindells, S; Singh, N // International Journal of STD & AIDS;Jul2001, Vol. 12 Issue 7, p463 

    Metabolic complications are being increasingly recognized among HIV-infected patients treated with potent combination antiretroviral therapies. We sought to assess the association of dyslipidaemia with adherence to protease inhibitor (PI) therapy and with the markers of clinical response to...

  • Treatment of primary HIV-1 infection with cyclosporin A coupled with highly active antiretroviral therapy. Rizzardi, G. Paolo; Harari, Alexandre; Capiluppi, Brunella; Tambussi, Giuseppe; Ellefsen, Kim; Ciuffreda, Donatella; Champagne, Patrick; Bart, Pierre-Alexandre; Chave, Jean-Philippe; Lazzarin, Adriano; Pantaleo, Giuseppe // Journal of Clinical Investigation;3/1/2002, Vol. 109 Issue 5, p681 

    Primary HIV-1 infection causes extensive immune activation, during which CD4(+) T cell activation supports massive HIV-1 production. We tested the safety and the immune-modulating effects of combining cyclosporin A (CsA) treatment with highly active antiretroviral therapy (HAART) during primary...

  • Improved Virological Outcomes in British Columbia Concomitant with Decreasing Incidence of HIV Type 1 Drug Resistance Detection. Gill, Vikram S.; Lima, Viviane D.; Wen Zhang; Wynhoven, Brian; Yip, Benita; Hogg, Robert S.; Montaner, Julio S. G.; Richard Harrigan, P. // Clinical Infectious Diseases;1/1/2010, Vol. 50 Issue 1, p98 

    Background. There have been limited studies evaluating temporal changes in the incidence of detection of drug resistance among human immunodeficiency virus type 1 (HIV-1) isolates and concomitant changes in plasma HIV load for treated individuals in a population-wide setting. Methods....

  • A Measurement Model of Medication Adherence to Highly Active Antiretroviral Therapy and Its Relation to Viral Load in HIV-Positive Adults. Llabre, Maria M.; Weaver, Kathryn E.; Durán, Ron E.; Antoni, Michael H.; McPherson-Baker, Shvawn; Schneiderman, Neil // AIDS Patient Care & STDs;Oct2006, Vol. 20 Issue 10, p701 

    This study compared a multiple method measurement model of highly active antiretroviral therapy (HAART) adherence with single-method models to determine optimal validity in predicting HIV viral load. Repeated measures of antiretroviral adherence were collected over a 15-month period using three...

  • HIV treatment prevents transmission of HIV.  // Africa Health;May2011, Vol. 33 Issue 4, p11 

    The article discusses the report from the US National Institutes of Health which found that an effective antiretroviral therapy regimen for HIV-positive person could prevent the risk of transmitting the virus to their uninfected sexual partner.

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics