For the purpose of this study, care and treatment were defined as the full range of facility-level, HIV-related medical services provided to the patient from the time the patient is enrolled on ART. Specifically, this included the costs of antiretroviral medications (ARVs), opportunistic infection medications (OIs), laboratory costs, nutritional support, direct and indirect personnel, facility-level training, equipment, clinical and non-clinical supplies, building maintenance and other administrative support costs. Equipment, building and supply costs were amortized. The costs of adherence and other support programs were captured where they were incurred at the facility (e.g., community health workers were paid through the facility). Treatment-related costs incurred outside of primary facilities, such as lab costs at tertiary facilities associated with diagnosis of opportunistic infections or patient monitoring, were also included.
However, HIV testing before ART initiation and treatment-related costs outside of the facility were not captured. For example, medical care (e.g., inpatient care) delivered at referral sites would have required patient-level or cohort analysis. Laboratory sample transport and supply chain costs, which were not accounted for in commodity pricing, were excluded. The study did not capture the cost of supervision or other associated managerial and support for facilities implemented above the facility-level by the government, donors or implementing partners. Non-medical interventions such as outreach, income-generating activities and interventions for orphans and vulnerable children were also excluded.
Data sources included retrospective program records such as patient registers, account ledgers, pharmacy stock cards and other facility documentation. Once cost data was collected for the facility, the unit cost per patient-year was derived through the allocation described below:
This “top-down” allocation was replaced with a “bottom-up” or normative calculation of ARV costs where there were severe data limitations. ARV costs were generally measured by calculating facility consumption from initial and final stock on pharmacy stock cards, and then allocating total consumption to different patient types as described above. However, where stock card data was considered unreliable or of poor quality, the final ARV cost ppy was calculated using the site's regimen mix and a normative cost per patient-year by regimen. Therefore the facility-level expenditure after stock-outs and product expiry was not captured consistently.
Local currency was converted to US dollars using the average conversion rate during the survey period. Nominal costs for each cost data year are presented here.
However, HIV testing before ART initiation and treatment-related costs outside of the facility were not captured. For example, medical care (e.g., inpatient care) delivered at referral sites would have required patient-level or cohort analysis. Laboratory sample transport and supply chain costs, which were not accounted for in commodity pricing, were excluded. The study did not capture the cost of supervision or other associated managerial and support for facilities implemented above the facility-level by the government, donors or implementing partners. Non-medical interventions such as outreach, income-generating activities and interventions for orphans and vulnerable children were also excluded.
Data sources included retrospective program records such as patient registers, account ledgers, pharmacy stock cards and other facility documentation. Once cost data was collected for the facility, the unit cost per patient-year was derived through the allocation described below:
This “top-down” allocation was replaced with a “bottom-up” or normative calculation of ARV costs where there were severe data limitations. ARV costs were generally measured by calculating facility consumption from initial and final stock on pharmacy stock cards, and then allocating total consumption to different patient types as described above. However, where stock card data was considered unreliable or of poor quality, the final ARV cost ppy was calculated using the site's regimen mix and a normative cost per patient-year by regimen. Therefore the facility-level expenditure after stock-outs and product expiry was not captured consistently.
Local currency was converted to US dollars using the average conversion rate during the survey period. Nominal costs for each cost data year are presented here.
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