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Impact and economic evaluation of a novel HIV service delivery model in rural Malawi.

Impact and economic evaluation of a novel HIV service delivery model in rural Malawi.
Author Information (click to view)

McBain RK, Petersen E, Tophof N, Dunbar EL, Kalanga N, Nazimera L, Mganga A, Dullie L, Mukherjee J, Wroe EB,


McBain RK, Petersen E, Tophof N, Dunbar EL, Kalanga N, Nazimera L, Mganga A, Dullie L, Mukherjee J, Wroe EB, (click to view)

McBain RK, Petersen E, Tophof N, Dunbar EL, Kalanga N, Nazimera L, Mganga A, Dullie L, Mukherjee J, Wroe EB,

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AIDS (London, England) 31(14) 1999-2006 doi 10.1097/QAD.0000000000001578

Abstract
OBJECTIVE
We performed an impact and cost-effectiveness analysis of a novel HIV service delivery model in a high prevalence, remote district of Malawi with a population of 143 800 people.

DESIGN
A population-based retrospective analysis of 1-year survival rates among newly enrolled HIV-positive patients at 682 health facilities throughout Malawi, comparing facilities implementing the service delivery model (n = 13) and those implementing care-as-usual (n = 669).

METHODS
Through district-level health surveillance data, we evaluated 1-year survival rates among HIV patients newly enrolled between July 2013 and June 2014 – representing 129 938 patients in care across 682 health facilities – using a multilevel modeling framework. The model, focused on social determinants of health, was implemented throughout Neno District at 13 facilities and compared with facilities in all other districts. Activity-based costing was used to annualize financial and economic costs from a societal perspective. Incremental cost-effectiveness ratios were expressed as quality-adjusted life-years gained.

RESULTS
The national average 1-year survival rate for newly enrolled antiretroviral therapy clients was 78.9%: this rate was 87.9% in Neno District, compared with 78.8% across all other districts in Malawi (P < 0.001; 95% confidence interval: 0.079-0.104). The economic cost of receiving care in Neno district (n = 6541 patients) was $317/patient/year, compared with an estimated $219/patient in other districts. This translated to $906 per quality-adjusted life-year gained. CONCLUSION
Neno District’s comprehensive model of care, featuring a strong focus on the community, is $98 more expensive per capita per annum but demonstrates superior 1-year survival rates, despite its remote location. Moreover, it should be considered cost-effective by traditional international standards.

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