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

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 pati...

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Veröffentlicht in:AIDS (London) 2017-09, Vol.31 (14), p.1999-2006
Hauptverfasser: McBain, Ryan K, Petersen, Elizabeth, Tophof, Nora, Dunbar, Elizabeth L, Kalanga, Noel, Nazimera, Lawrence, Mganga, Andrew, Dullie, Luckson, Mukherjee, Joia, Wroe, Emily B
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Sprache:eng
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Zusammenfassung: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 
ISSN:0269-9370
1473-5571
DOI:10.1097/QAD.0000000000001578