TY - JOUR
T1 - Patient-incurred costs in a differentiated service delivery club intervention compared to standard clinical care in Northwest Tanzania
AU - Okere, Nwanneka E.
AU - Corball, Lucia
AU - Kereto, Dunia
AU - Hermans, Sabine
AU - Naniche, Denise
AU - Rinke de Wit, Tobias F.
AU - Gomez, Gabriela B.
N1 - Funding Information: The Shinyanga and Simiyu Test & Treat programme in Tanzania is supported by Gilead Sciences (USA) and the Diocese of Shinyanga through the Good Samaritan Foundation (Vatican). The implementation of the project is by Doctors with Africa CUAMM and the Diocese of Shinyanga within the framework set out in the national guidance of the Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) through the National AIDS Control Program (NACP). The scientific evaluation of the project is under the guidance of Principal Investigators Prof Anton Pozniak and Dr. Bernard Desderius and is performed by the Amsterdam Institute for Global Health and Development (AIGHD) in collaboration with Doctors with Africa CUAMM. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions mentioned above. We thank all our institutional collaborators, the study participants, the staff at the project clinical sites and laboratories, as well as the project support staff for their invaluable support to this programme in general and this manuscript in particular. Funding Information: The Shinyanga T&T project is supported by Gilead Sciences Inc. ONE was supported by the Erasmus Mundus Joint Doctorate Trans Global Health Programme (EMJD-TGH) and the Amsterdam Institute for Global Health and Development (AIGHD). The funders had no role in the design, plan for data collection, analysis, interpretation and writing of this article. The Shinyanga and Simiyu Test & Treat programme in Tanzania is supported by Gilead Sciences (USA) and the Diocese of Shinyanga through the Good Samaritan Foundation (Vatican). The implementation of the project is by Doctors with Africa CUAMM and the Diocese of Shinyanga within the framework set out in the national guidance of the Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) through the National AIDS Control Program (NACP). The scientific evaluation of the project is under the guidance of Principal Investigators Prof Anton Pozniak and Dr. Bernard Desderius and is performed by the Amsterdam Institute for Global Health and Development (AIGHD) in collaboration with Doctors with Africa CUAMM. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions mentioned above. We thank all our institutional collaborators, the study participants, the staff at the project clinical sites and laboratories, as well as the project support staff for their invaluable support to this programme in general and this manuscript in particular. The Shinyanga T&T project is supported by Gilead Sciences Inc. ONE was supported by the Erasmus Mundus Joint Doctorate Trans Global Health Programme (EMJD-TGH) and the Amsterdam Institute for Global Health and Development (AIGHD). The funders had no role in the design, plan for data collection, analysis, interpretation and writing of this article. Funding Information: The Shinyanga T&T project is supported by Gilead Sciences Inc. ONE was supported by the Erasmus Mundus Joint Doctorate Trans Global Health Programme (EMJD‐TGH) and the Amsterdam Institute for Global Health and Development (AIGHD). The funders had no role in the design, plan for data collection, analysis, interpretation and writing of this article. Publisher Copyright: © 2021 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Introduction: Placing all clients with a positive diagnosis for HIV on antiretroviral therapy (ART) has cost implications both for patients and health systems, which could, in turn, affect feasibility, sustainability and uptake of new services. Patient-incurred costs are recognized barriers to healthcare access. Differentiated service delivery (DSD) models in general and community-based care in particular, could reduce these costs. We aimed to assess patient-incurred costs of a community-based DSD intervention (clubs) compared to clinic-based care in the Shinyanga region, Tanzania. Methods: Cross-sectional survey among stable ART patients (n = 390, clinic-based; n = 251, club-based). For each group, we collected socio-demographic, income and expenditure data between May and August 2019. We estimated direct and indirect patient-incurred costs. Direct costs included out-of-pocket expenditures. Indirect costs included income loss due to time spent during transport, accessing services and off work during illness. Cost drivers were assessed in multivariate regression models. Results: Overall, costs were significantly higher among clinic participants. Costs (USD) per year for clinic versus club were as follows: 11.7 versus 4.17 (p < 0.001) for direct costs, 20.9 versus 8.23 (p < 0.001) for indirect costs and 32.2 versus 12.4 (p < 0.001) for total costs. Time spent accessing care and time spent in illness (hours/year) were 38.3 versus 13.8 (p < 0.001) and 16.0 versus 6.69 (p < 0.001) respectively. The main cost drivers included transportation (clinic vs. club: 67.7% vs. 44.1%) for direct costs and income loss due to time spent accessing care (clinic vs. club: 60.4% vs. 56.7%) for indirect costs. Factors associated with higher total costs among patients attending clinic services were higher education level (coefficient [95% confidence interval]) 20.9 [5.47 to 36.3]) and formal employment (44.2 [20.0 to 68.5). Differences in mean total costs remained significantly higher with formal employment, rural residence, in addition to more frequent visits among clinic participants. The percentage of households classified as having had catastrophic expenditures in the last year was low but significantly higher among clinic participants (10.8% vs. 5.18%, p = 0.014). Conclusions: Costs incurred by patients accessing DSD in the community are significantly lower compared to those accessing standard clinic-based care. DSD models could improve access, especially in resource-limited settings.
AB - Introduction: Placing all clients with a positive diagnosis for HIV on antiretroviral therapy (ART) has cost implications both for patients and health systems, which could, in turn, affect feasibility, sustainability and uptake of new services. Patient-incurred costs are recognized barriers to healthcare access. Differentiated service delivery (DSD) models in general and community-based care in particular, could reduce these costs. We aimed to assess patient-incurred costs of a community-based DSD intervention (clubs) compared to clinic-based care in the Shinyanga region, Tanzania. Methods: Cross-sectional survey among stable ART patients (n = 390, clinic-based; n = 251, club-based). For each group, we collected socio-demographic, income and expenditure data between May and August 2019. We estimated direct and indirect patient-incurred costs. Direct costs included out-of-pocket expenditures. Indirect costs included income loss due to time spent during transport, accessing services and off work during illness. Cost drivers were assessed in multivariate regression models. Results: Overall, costs were significantly higher among clinic participants. Costs (USD) per year for clinic versus club were as follows: 11.7 versus 4.17 (p < 0.001) for direct costs, 20.9 versus 8.23 (p < 0.001) for indirect costs and 32.2 versus 12.4 (p < 0.001) for total costs. Time spent accessing care and time spent in illness (hours/year) were 38.3 versus 13.8 (p < 0.001) and 16.0 versus 6.69 (p < 0.001) respectively. The main cost drivers included transportation (clinic vs. club: 67.7% vs. 44.1%) for direct costs and income loss due to time spent accessing care (clinic vs. club: 60.4% vs. 56.7%) for indirect costs. Factors associated with higher total costs among patients attending clinic services were higher education level (coefficient [95% confidence interval]) 20.9 [5.47 to 36.3]) and formal employment (44.2 [20.0 to 68.5). Differences in mean total costs remained significantly higher with formal employment, rural residence, in addition to more frequent visits among clinic participants. The percentage of households classified as having had catastrophic expenditures in the last year was low but significantly higher among clinic participants (10.8% vs. 5.18%, p = 0.014). Conclusions: Costs incurred by patients accessing DSD in the community are significantly lower compared to those accessing standard clinic-based care. DSD models could improve access, especially in resource-limited settings.
KW - Tanzania
KW - antiretroviral treatment
KW - catastrophic costs
KW - costs
KW - differentiated service delivery
KW - patient-incurred costs
UR - http://www.scopus.com/inward/record.url?scp=85108849493&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/jia2.25760
DO - https://doi.org/10.1002/jia2.25760
M3 - Article
C2 - 34164916
SN - 1758-2652
VL - 24
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
IS - 6
M1 - e25760
ER -