Table 5. Breakdown of cost per patient at 12 months, by model (cost and percentage of total mean cost/patient).
| Country and model | ARVs | Non-ARV
medications |
Lab tests | Clinic visits | DSD
interactions |
Infrastructure
and fixed costs |
||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lesotho | ||||||||||||
| Facility care with 3-month refills (SOC) | $84.37 | 69% | * | $12.00 | 10% | $25.91 | 21% | $0 | 0% | † | ||
| Community ART groups with 3-month
refills |
$86.10 | 75% | * | $8.93 | 8% | $5.78 | 5% | $13.59 | 12% | † | ||
| Community distribution points with 6-
month refills |
$87.08 | 77% | * | $10.29 | 9% | $9.60 | 9% | $5.59 | 5% | † | ||
| Malawi ¶ | ||||||||||||
| Facility conventional care (SOC) | $77.54 | 87% | * | ‡ | $8.19 | 9% | $0 | 0% | $3.32 | 4% | ||
| Facility dispensing with 3-month refills | $77.65 | 88% | * | ‡ | $7.43 | 8% | $0 | 0% | $3.32 | 4% | ||
| Facility dispensing with 6-month refills | $78.18 | 91% | * | ‡ | $4.42 | 5% | $0 | 0% | $3.32 | 4% | ||
| Uganda ** | ||||||||||||
| Facility-based individual management
(SOC) |
$115.33 | 76% | $9.99 | 7% | $13.04 | 9% | $5.00 | 3% | $0.00 | 0% | $9.12 | 6% |
| Facility groups (pregnant/post-partum) | $96.88 | 69% | $13.13 | 9% | $14.85 | 11% | $6.90 | 5% | $0.06 | 0% | $9.46 | 7% |
| Fast-track drug refills | $133.96 | 80% | $11.10 | 7% | $11.75 | 7% | $4.77 | 3% | $0.00 | 0% | $4.89 | 3% |
| Client-led ART delivery | $103.20 | 69% | $20.10 | 13% | $11.21 | 7% | $2.55 | 2% | $0.17 | 0% | $12.84 | 9% |
| Community distribution points | $112.76 | 77% | $10.12 | 7% | $11.40 | 8% | $1.47 | 1% | $0.17 | 0% | $10.51 | 7% |
| Zambia1 § | ||||||||||||
| Facility conventional care (SOC) | $86.04 | 86% | $0.13 | 0% | $4.61 | 5% | 9.31 | 9% | $0 | 0% | † | |
| Community adherence groups | $89.01 | 77% | $0.10 | 0% | $6.92 | 6% | $9.63 | 8% | $9.92 | 9% | † | |
| Urban adherence groups | $101.87 | 69% | $0.18 | 0% | $23.24 | 16% | $11.16 | 8% | $10.68 | 7% | † | |
| Mobile ART services | $73.30 | 60% | $3.45 | 3% | ‡ | $0.00 | 0% | $45.71 | 37% | † | ||
| Home ART delivery | $87.96 | 64% | $0.18 | 0% | $4.56 | 3% | $3.70 | 3% | $40.78 | 30% | † | |
| Zambia2 ¶ | ||||||||||||
| Facility conventional care (SOC) | $109.65 | 76% | * | ‡ | $31.75 | 22% | $0 | 0% | $2.20 | 2% | ||
| Facility dispensing with 3-month refills | $106.71 | 75% | * | ‡ | $32.69 | 23% | $0 | 0% | $2.20 | 2% | ||
| Facility dispensing with 6-month refills | $109.45 | 83% | * | ‡ | $19.48 | 15% | $0 | 0% | $2.20 | 2% | ||
| Zimbabwe ¶ | ||||||||||||
| Facility dispensing with 3-month refills
(SOC) |
$164.17 | 84% | * | $6.90 | 4% | $23.98 | 12% | $0 | 0% | † | ||
| Community ART groups with 3-month
refills |
$163.45 | 89% | * | $6.43 | 4% | $9.23 | 5% | $3.70 | 2% | † | ||
| Community ART groups with 6-month
refills |
$161.08 | 93% | * | $1.08 §§ | 1% | $9.22 | 5% | $1.42 | 1% | † | ||
*Non-ARV medication costs not captured.
†Infrastructure and other fixed costs included in clinic visit costs.
‡Laboratory costs not captured; one viral load test per year, as called for by national guidelines, would add approximately $19 to the mean annual cost per patient per year.
§For Zambia1, on-site pharmacy costs were included in clinic visit costs.
¶Costs for Malawi, Zambia2, and Zimbabwe are only for those who were retained at 12 months.
**For Uganda, 1) medication costs include supply chain costs, not solely procurement of products; 2) lab tests included tests other than viral loads; and 3) infrastructure and fixed costs included some costs incurred by implementing partners above the level of the individual healthcare facility.
§§In Zimbabwe, facilities in the study arm with community ART groups with 6 month refills were more likely to be located in districts that did not have access to viral load testing technology. As a result, far fewer patients received viral load tests than in the other arms ( Table 4), and average cost per patient was low.