AEGiS-15IAC: Cost and enrollment implications of different target populations in the rapid scale-up of antiretroviral treatment programs.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Cost and enrollment implications of different target populations in the rapid scale-up of antiretroviral treatment programs.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WeOrB1281)

Fusco H, Chi B, Sinkala M, Stringer JS
Center for Infectious Disease Research in Zambia, Lusaka, Zambia

BACKGROUND: Rapid scale-up of antiretroviral therapy (ART) programs is now a worldwide priority and ambitious targets for numbers of people on ART have been set. PMTCT has been targeted as a primary entry point for ART, often to the exclusion of other populations, such as tuberculosis patients (pts) or medical inpatients. We analyzed the cost-efficiency of targeting either antenatal (ANC) clinic attendees or tuberculosis (TB) pts as entry points for a family-based ART program.

METHODS: We designed a conditional probability model with estimates/costs derived from the medical literature and our experience in Lusaka, Zambia. Model estimates that differed between the two strategies included HIV prevalence (ANC 25% vs. TB 70%), ART eligibility if seropositive (ANC 20% vs. TB 80%), and willingness to start ART if eligible (ANC 50% vs. TB 95%). Estimates that were the same for each strategy included HIV testing uptake (70%), HIV prevalence in spouse of infected index patient (60%), spouse ART eligibil ity (20%), and spouse willingness to start therapy (50%). Costs included HIV testing visits (US$3) and clinical/lab evaluation for ART eligibility (US$22).

RESULTS: [table: see text] Under a policy where all HIV co-infected TB pts receive ART(as suggested by some), the screening cost per enrollee drops(US$40), while the number started on ART per 10,000 rises (4,637). Only 1,078 TB clinic attendees would need to be screened to start500 on ART and therapy could be initiated for 13,910 in Lusakaalone.

CONCLUSIONS: Though the rapid scale up of any ART program should involve multiple source populations, this analysis demonstrates the relative efficiency of targeting TB clinic attendees. Other high prevalence/ill populations (e.g. medical inpatients) would be expected to yield similar efficiencies.

Keywords: AEGIS, Health Services Needs and Demand, Tuberculosis, HIV Seropositivity, Prevalence, Acquired Immunodeficiency Syndrome, Cost-Benefit Analysis, Health Care Costs, Mass Screening, Zambia, Humans, economics, therapy

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