Establishing the Cost-Effectiveness of Different Models of Antiretroviral Treatment Programs Across Clinical Sites in Southern Africa in Urban and Rural Settings
Principal Investigator:
- Richard G. Marlink, M.D.,
Elizabeth Glaser Pediatric AIDS Foundation
Co-Investigators:
- Robert A. Pawinski, M.B.Ch.B.,
Nelson R. Mandela School of Medicine - Helga Holst, M.D., McCord Hospital
Abstract
Sub-Saharan Africa is the area most affected by HIV/AIDS in the world. It is currently in a phase of rapid scale-up of the largest antiretroviral treatment (ART) programs worldwide. Little evidence exists to assist policy makers with optimally utilizing resources for maximal clinical outcomes.
This two-year operational research program is a collaboration between the Elizabeth Glaser Pediatric AIDS Foundation, the Enhancing Care Initiative, KwaZulu-Natal (KZN), Nelson R. Mandela School of Medicine and McCord Hospital. The overall goal of the project is to establish the cost-effectiveness of different models of antiretroviral treatment programs across clinical sites in southern Africa in both urban and rural settings.
The aims of this study include comparing the immunological, virological and clinical outcomes of ART under different models of care; estimating the financial and economic cost of providing a comprehensive model of ART at each site; and identifying the incremental costs and cost-effectiveness of differences within models of ART (e.g. doctor-centered approaches versus nurse-centered approaches or urban versus rural approaches to care).
To achieve these goals, we will examine the clinical outcomes, financial and economic costs and cost-effectiveness of ART programs at three research sites in KZN Province, South Africa. A secondary but important outcome of this study will be to build monitoring and evaluation capacity at each implementation site, as well as enhanced patient tracking systems.
The information generated by this study can contribute to answering questions about the optimal use of human resources and cost-effectiveness of different models of ART more generally, as well as provide opportunities to answer important clinical questions.
The results of this study will be useful in informing policy-making and HIV treatment guidelines in resource-limited settings, where ART needs to be scaled up. The investigators hope that the results of this study will assist with optimizing care to millions of patients infected with HIV who will be receiving HAART in the future.