| dc.description.abstract |
Objective: Sub-Saharan Africa faces twin epidemics of HIV and noncommunicable diseases
including hypertension. Integrating hypertension care into chronic HIV care is a global priority,
but cost estimates are lacking. In the SEARCH Study, we performed population-level
HIV/hypertension testing, and offered integrated streamlined chronic care. Here, we estimate costs
for integrated hypertension/HIV care for HIV-positive individuals, and costs for hypertension care
for HIV-negative individuals in the same clinics.
Design: Microcosting analysis of healthcare expenditures within Ugandan HIV clinics.
Methods: SEARCH (NCT: 01864603) conducted community health campaigns for diagnosis and
linkage to care for both HIV and hypertension. HIV-positive patients received hypertension/HIV
care jointly including blood pressure monitoring and medications; HIV-negative patients received
hypertension care at the same clinics. Within 10 Ugandan study communities during 2015-2016,
we estimated incremental annual per-patient hypertension care costs using micro-costing
techniques, time-and-motion personnel studies, and administrative/clinical records review.
Results: Overall, 70 HIV-positive and 2355 HIV-negative participants received hypertension care.
For HIV-positive participants, average incremental cost of hypertension care was $6.29 per person
per year, a 2.1% marginal increase over prior estimates for HIV care alone. For HIV-negative
participants, hypertension care cost $11.39 per person per year, a 3.8% marginal increase over HIV
care costs. Key costs for HIV-positive patients included hypertension medications ($6.19 per
patient per year; 98% of total) and laboratory testing ($0.10 per patient per year; 2%). Key costs
for HIV-negative patients included medications ($5.09 per patient per year; 45%) and clinic staff
salaries ($3.66 per patient per year; 32%).
Conclusion: For only 2-4% estimated additional costs, hypertension care was added to HIV care,
and also expanded to all HIV-negative patients in prototypic Ugandan clinics, demonstrating
substantial synergy. Our results should encourage accelerated scale-up of hypertension care into
existing clinics |
en_US |