Retrospective Cost-Effectiveness Analysis for Nurse Initiated and Managed Antiretroviral Treatment for HIV/AIDS in South Africa

In HIV/AIDS treatment programs in resource-constrained settings, one response to a shortage of doctors and other highly trained healthcare providers is “task-shifting” from doctors to less trained clinicians, such as nurses and community healthcare workers. In 2010, South Africa issued new guidelines for its antiretroviral treatment (ART) program to allow senior nurses to initiate and manage adult ART patients at primary health clinics. This policy, known as NIMART (Nurse Initiated and Managed Antiretroviral Therapy) is gradually being implemented around the country. Although it is widely assumed that NIMART will save money, as well as human resources, there are no published estimates that compare the actual costs of treatment between specialized, doctor-managed, accredited ART sites (called CCMT sites) and NIMART sites or offer a direct comparison of patient outcomes in the same populations. This study seeks to estimate the costs of the two models of treatment delivery, describe the outcomes achieved by patients and assess the cost-effectiveness of the alternative strategies. Findings from the study will assist the national government, provincial departments of health and other stakeholders to estimate resource needs, increase efficiency among existing providers and target future investments to cost-effective models of delivery.