Cost and Cost-Effectiveness of Antiretroviral Treatment Delivery in Resource Constrained Settings

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In most countries with high HIV prevalence, the demand for treatment with antiretroviral therapy (ART) has rapidly outstripped the capacity of traditional tertiary health-care facilities (hospitals) to provide that treatment. If national and international targets for treatment access are to be met, ART will therefore need to be delivered in a wide range of settings and at multiple levels of the health-care system, from large referral hospitals in capital cities to primary health-care clinics in rural areas. Different models of treatment delivery may result in different patient outcomes, as measured by the proportions of patients who remain in care and responsive to therapy, remain in care but fail to respond to therapy, and do not remain in care at all. Similarly, the cost per patient initiated on ARTand the cost per patient retained in care and responding to therapy are likely to differ based on facility characteristics, such as setting (urban, peri-urban, rural), level (hospital, clinic, mobile clinic, general practitioner’s office), sector (public, private, nongovernmental), professional inputs (doctor and nurse time), and scale (number of patients treated). More

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From the Ground Up
#Section III Chapter 2
Elizabeth Glazer Foundation