Estimating the cost of increasing retention in care for HIV-infected patients

Results of the CDC/HRSA retention in care trial

Ram K. Shrestha, Lytt Gardner, Gary Marks, Jason Craw, Faye Malitz, Thomas P. Giordano, Meg Sullivan, Jeanne C Keruly, Allan Rodriguez, Tracey E. Wilson, Michael Mugavero

Research output: Contribution to journalArticle

Abstract

Background: Retaining HIV patients in medical care promotes access to antiretroviral therapy, viral load suppression, and reduced HIV transmission to partners. We estimate the programmatic costs of a US multisite randomized controlled trial of an intervention to retain HIV patients in care. Methods: Six academically affiliated HIV clinics randomized patients to intervention (enhanced personal contact with patients across time coupled with basic HIV education) and control [standard of care (SOC)] arms. Retention in care was defined as 4-month visit constancy, that is, at least 1 primary care visit in each 4-month interval over a 12-month period. We used microcosting methods to collect unit costs and measure the quantity of resources used to implement the intervention in each clinic. All fixed and variable labor and nonlabor costs of the intervention were included. Results: Visit constancy was achieved by 45.7% (280/613) of patients in the SOC arm and by 55.8% (343/615) of patients in the intervention arm, representing an increase of 63 patients (relative improvement 22.1%; 95% confidence interval: 9% to 36%; P <0.01). The total annual cost of the intervention at the 6 clinics was $241,565, the average cost per patient was $393, and the estimated cost per additional patient retained in care beyond SOC was $3834. Conclusions: Our analyses showed that a retention in care intervention consisting of enhanced personal contact coupled with basic HIV education may be delivered at fairly low cost. These results provide useful information for guiding decisions about planning or scaling-up retention in care interventions for HIV-infected patients.

Original languageEnglish (US)
Pages (from-to)345-350
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes
Volume68
Issue number3
DOIs
StatePublished - Mar 1 2015

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Centers for Disease Control and Prevention (U.S.)
HIV
Costs and Cost Analysis
Standard of Care
Education
Viral Load
Primary Health Care
Patient Care
Randomized Controlled Trials
Confidence Intervals

Keywords

  • cost study
  • etention in care
  • HIV
  • microcosting

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Estimating the cost of increasing retention in care for HIV-infected patients : Results of the CDC/HRSA retention in care trial. / Shrestha, Ram K.; Gardner, Lytt; Marks, Gary; Craw, Jason; Malitz, Faye; Giordano, Thomas P.; Sullivan, Meg; Keruly, Jeanne C; Rodriguez, Allan; Wilson, Tracey E.; Mugavero, Michael.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 68, No. 3, 01.03.2015, p. 345-350.

Research output: Contribution to journalArticle

Shrestha, RK, Gardner, L, Marks, G, Craw, J, Malitz, F, Giordano, TP, Sullivan, M, Keruly, JC, Rodriguez, A, Wilson, TE & Mugavero, M 2015, 'Estimating the cost of increasing retention in care for HIV-infected patients: Results of the CDC/HRSA retention in care trial', Journal of Acquired Immune Deficiency Syndromes, vol. 68, no. 3, pp. 345-350. https://doi.org/10.1097/QAI.0000000000000462
Shrestha, Ram K. ; Gardner, Lytt ; Marks, Gary ; Craw, Jason ; Malitz, Faye ; Giordano, Thomas P. ; Sullivan, Meg ; Keruly, Jeanne C ; Rodriguez, Allan ; Wilson, Tracey E. ; Mugavero, Michael. / Estimating the cost of increasing retention in care for HIV-infected patients : Results of the CDC/HRSA retention in care trial. In: Journal of Acquired Immune Deficiency Syndromes. 2015 ; Vol. 68, No. 3. pp. 345-350.
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