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dc.contributor.authorMenzies, Nicolas Alan
dc.contributor.authorBerruti, Andres A.
dc.contributor.authorBlandford, John M.
dc.date.accessioned2013-04-25T18:41:06Z
dc.date.issued2012
dc.identifier.citationMenzies, Nicolas A., Andres A. Berruti, and John M. Blandford. 2012. The determinants of HIV treatment costs in resource limited settings. PLoS ONE 7(11): e48726.en_US
dc.identifier.issn1932-6203en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:10587992
dc.description.abstractBackground: Governments and international donors have partnered to provide free HIV treatment to over 6 million individuals in low and middle-income countries. Understanding the determinants of HIV treatment costs will help improve efficiency and provide greater certainty about future resource needs. Methods and Findings: We collected data on HIV treatment costs from 54 clinical sites in Botswana, Ethiopia, Mozambique, Nigeria, Uganda, and Vietnam. Sites provided free HIV treatment funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), national governments, and other partners. Service delivery costs were categorized into successive six-month periods from the date when each site began HIV treatment scale-up. A generalized linear mixed model was used to investigate relationships between site characteristics and per-patient costs, excluding ARV expenses. With predictors at their mean values, average annual per-patient costs were $177 (95% CI: 127–235) for pre-ART patients, $353 (255–468) for adult patients in the first 6 months of ART, and $222 (161–296) for adult patients on ART for >6 months (excludes ARV costs). Patient volume (no. patients receiving treatment) and site maturity (months since clinic began providing treatment services) were both strong independent predictors of per-patient costs. Controlling for other factors, costs declined by 43% (18–63) as patient volume increased from 500 to 5,000 patients, and by 28% (6–47) from 5,000 to 10,000 patients. For site maturity, costs dropped 41% (28–52) between months 0–12 and 25% (15–35) between months 12–24. Price levels (proxied by per-capita GDP) were also influential, with costs increasing by 22% (4–41) for each doubling in per-capita GDP. Additionally, the frequency of clinical follow-up, frequency of laboratory monitoring, and clinician-patient ratio were significant independent predictors of per-patient costs. Conclusions: Substantial reductions in per-patient service delivery costs occur as sites mature and patient cohorts increase in size. Other predictors suggest possible strategies to reduce per-patient costs.en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pone.0048726en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492412/pdf/en_US
dash.licenseLAA
dc.subjectMedicineen_US
dc.subjectGlobal Healthen_US
dc.subjectInfectious Diseasesen_US
dc.subjectViral Diseasesen_US
dc.subjectHIVen_US
dc.subjectSexually Transmitted Diseasesen_US
dc.subjectNon-Clinical Medicineen_US
dc.subjectHealth Care Policyen_US
dc.subjectHealth Economicsen_US
dc.subjectPublic Healthen_US
dc.subjectSocial and Behavioral Sciencesen_US
dc.subjectEconomicsen_US
dc.subjectHuman Capitalen_US
dc.subjectEconomics of Healthen_US
dc.titleThe Determinants of HIV Treatment Costs in Resource Limited Settingsen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS ONEen_US
dash.depositing.authorMenzies, Nicolas Alan
dc.date.available2013-04-25T18:41:06Z
dc.identifier.doi10.1371/journal.pone.0048726*
dash.contributor.affiliatedMenzies, Nicolas


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