Do differentiated models of care for HIV treatment result in lower costs for recipients of care in Zambia?


BACKGROUND: One of the benefits that differentiated service delivery (DSD) models for HIV treatment are assumed to generate is a reduction in direct and indirect costs to recipients of care (RoC), but the savings that come with reduced costs must vary among the widely diverse DSD models. We estimated the costs to RoC of nine discrete models currently in routine use in Zambia, compared to conventional care.
METHODS: From May to November 2021 we surveyed RoC at 12 clinics in two provinces of Zambia. Participants were selected consecutively on their arrival for routine visits, with stratification by DSD model participation, and asked about time spent and transport costs incurred when accessing care. We calculated the cost/health system interaction (clinic and out-of-facility) and multiplied by the participant-reported number of interactions per year to estimate an opportunity cost (using the country-specific minimum wage of $1.99/day) and transport cost/RoC/year by model of care.
RESULTS: We surveyed 558 RoC (median age 38, 72% female). Conventional care required four facility visits year, while most (but not all) DSD models reduced facility visits to two per year, with or without additional external interactions such as adherence club meetings or community medication pickups (Figure). Depending on the model, opportunity costs to RoC ranged from roughly 1 to 3 days' minimum wage. Fewer than half of RoC incurred any transport costs; for those who did, the cost averaged 1-1.5 days' minimum wage. Variation in transport costs among models may reflect RoC choices about paying for transport based on how many interactions will be required and the locations of the interactions.

CONCLUSIONS: DSD models generally minimise costs and time for RoC as compared to conventional care, but this depends entirely on model design (number of interactions required/year). Implementing models that minimize RoC interactions with the healthcare system and model events may improve outcomes.

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