HIV/AIDS in South Africa: "Few very young children accessed ART in either clinic and those who did were already very ill"

http://www.ncbi.nlm.nih.gov/pubmed/23014517

AIDS. 2012 Sep 25. [Epub ahead of print]

Cost and outcomes of paediatric antiretroviral treatment in South Africa.

Meyer-Rath G, Brennan A, Long L, Ndibongo B, Technau K, Moultrie H, Fairlie L, Coovadia A, Rosen S.

Source

aCenter for Global Health and Development, Boston University, US bHealth Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa cDepartment of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa dEmpilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Johannesburg, SouthAfrica eWits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

OBJECTIVE:

Little is known about the cost of paediatric antiretroviral treatment (ART) in low- and middle-income countries. We analysed the average cost of providing paediatric ART in South Africa during the first two years after ART initiation, stratified by patient outcomes.

METHODS:

We collected data on outpatient resource use and treatment outcomes of 288 children in two Johannesburg public hospitals, Empilweni Services and Research Unit (ESRU) and Harriet Shezi Children's Clinic (HSCC) from 2005 and 2009. Patient-level resource use was estimated from patient records. Unit cost data came from site accounts and public-sector sources. Patient outcomes at month 12 and 24 after initiation were defined based on weights, CD4 cell counts/percentages, viral loads, and the presence of new WHO stage 3/4 conditions.

RESULTS:

Median age/mean CD4 percentage at initiation were 4.03 years/13.23% in ESRU and 5.84 years/14.61% in HSCC, respectively. 62% and 91% of patients remained in care and responding to treatment at month 12 in ESRU and HSCC, respectively, and 68% and 80% at month 24. The average cost per patient in care and responding was $830 in year 1 and $717 in year 2 in ESRU and $678 and $782 in HSCC. ARV drugs comprised 33-52% of total cost, clinic visits 23-31%, lab tests 12-16%, and fixed costs 8-18%.

CONCLUSIONS:

Costs varied between the two clinics but were comparable to those of adult ART. Few very young children accessed ART in either clinic and those who did were already very ill, emphasizing the importance of early infant treatment.