Cost and outcomes of paediatric antiretroviral treatment in South Africa

By  Dr Gesine Meyer-Rath  Alana Brennan  Dr. Lawrence Long  Buyiswa Ndibongo  Karl Technau  Harry Moultrie  Lee Fairlie  Ashraf Coovadia  Professor Sydney Rosen  |  | 


Objective: Little is known about the cost of paediatric antiretroviral treatment (ART) in low- and middle-income countries. We analysed the average cost of providing paediatric  ART in South Africa during the first two years after ART initiation, stratified by patient outcomes. Methods: We collected data on outpatient resource use and treatment outcomes of 288 children in two Johannesburg public hospitals, Empilweni Services and Research Unit (ESRU) and Harriet Shezi Children’s Clinic (HSCC) from 2005 and 2009. Patient-level resource use was estimated from patient records. Unit cost data came from site accounts and public-sector sources. Patient outcomes at month 12 and 24 after initiation were defined based on weights, CD4 cell counts/percentages, viral loads, and the presence of new WHO stage 3/4 conditions. Results: Median age/mean CD4 percentage at initiation were 4.03 years/13.23% in ESRU and 5.84 years/14.61% in HSCC, respectively. 62% and 91% of patients remained in care and responding to treatment at month 12 in ESRU and HSCC, respectively, and 68% and 80% at month 24. The average cost per patient in care and responding was $830 in year 1 and $717 in year 2 in ESRU and $678 and $782 in HSCC. ARV drugs comprised 33–52% of total cost, clinic visits 23–31%, lab tests 12– 16%, and fixed costs 8–18%. Conclusions: Costs varied between the two clinics but were comparable to those of adult ART. Few very young children accessed ART in either clinic and those who did were already very ill, emphasizing the importance of early infant treatment.




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