Cost-effectiveness analysis of a community-based model for delivery of antiretroviral therapy to people with clinically stable HIV in Cambodia

IF 4.9 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2025-07-07 DOI:10.1002/jia2.26476

Lo Yan Esabelle Yam, Pheak Chhoun, Ziya Tian, Michiko Nagashima-Hayashi, Marina Zahari, Sovannary Tuot, Sovannarith Samreth, Bora Ngauv, Vichea Ouk, Kiesha Prem, Siyan Yi

{"title":"Cost-effectiveness analysis of a community-based model for delivery of antiretroviral therapy to people with clinically stable HIV in Cambodia","authors":"Lo Yan Esabelle Yam, Pheak Chhoun, Ziya Tian, Michiko Nagashima-Hayashi, Marina Zahari, Sovannary Tuot, Sovannarith Samreth, Bora Ngauv, Vichea Ouk, Kiesha Prem, Siyan Yi","doi":"10.1002/jia2.26476","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>In Cambodia, of all people living with HIV, 89% knew their status, 89% were receiving antiretroviral therapy (ART) and 87% had their viral load suppressed in 2023. In 2017, the national HIV programme introduced the multi-month dispensing (MMD) model to reduce visits to ART clinics, thereby reducing the burden on people living with HIV and health facilities. A quasi-experimental study introduced the community ART delivery (CAD) model, where community action workers (CAWs) delivered pre-packaged antiretrovirals to their peers in the community. This study examined the cost-effectiveness of the CAD compared to the MMD model.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This study was conducted between 2021 and 2023 and involved 2040 stable people living with HIV in the CAD arm and 2049 in the MMD arm. Baseline and endline surveys included self-reported ART adherence, quality of life, and medical and non-medical expenses. Intention-to-treat analyses (ITTs) were conducted based on participants’ original treatment assignment, with multiple imputations performed for participants lost to follow-up at the endline. Incremental cost-effectiveness ratios (ICERs) on ART adherence and quality of life were generated using health system and societal perspectives. Cost-effectiveness thresholds (CETs) were one-time gross domestic product (GDP) per capita and opportunity cost.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Both arms observed a decline in ART adherence and good physical health, with a decline in CAD less than in the MMD (<i>p</i>-value < 0.001). Similarly, a reduced proportion of participants reported good mental health across both arms; however, the difference was statistically insignificant. The ICERs for good physical health at the health system and societal levels were below the one-time GDP per capita (Incremental Net Benefit = 77.49−83.03) but exceeded the opportunity cost CET. The ICERs for ART adherence at the health system and societal levels were above both CETs.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The results showed that the CAD model was cost-effective in reducing the decline in the physical health of people living with HIV during the COVID-19 pandemic in Cambodia when a less stringent threshold was used. Further investigations are required to ascertain the cost-effectiveness of the CAD model by factoring in the productivity gains within the health system.</p>\n </section>\n \n <section>\n \n <h3> Clinical Trial Number</h3>\n \n <p>NCT04766710</p>\n </section>\n </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S3","pages":""},"PeriodicalIF":4.9000,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26476","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the International AIDS Society","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jia2.26476","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

In Cambodia, of all people living with HIV, 89% knew their status, 89% were receiving antiretroviral therapy (ART) and 87% had their viral load suppressed in 2023. In 2017, the national HIV programme introduced the multi-month dispensing (MMD) model to reduce visits to ART clinics, thereby reducing the burden on people living with HIV and health facilities. A quasi-experimental study introduced the community ART delivery (CAD) model, where community action workers (CAWs) delivered pre-packaged antiretrovirals to their peers in the community. This study examined the cost-effectiveness of the CAD compared to the MMD model.

Methods

This study was conducted between 2021 and 2023 and involved 2040 stable people living with HIV in the CAD arm and 2049 in the MMD arm. Baseline and endline surveys included self-reported ART adherence, quality of life, and medical and non-medical expenses. Intention-to-treat analyses (ITTs) were conducted based on participants’ original treatment assignment, with multiple imputations performed for participants lost to follow-up at the endline. Incremental cost-effectiveness ratios (ICERs) on ART adherence and quality of life were generated using health system and societal perspectives. Cost-effectiveness thresholds (CETs) were one-time gross domestic product (GDP) per capita and opportunity cost.

Results

Both arms observed a decline in ART adherence and good physical health, with a decline in CAD less than in the MMD (p-value < 0.001). Similarly, a reduced proportion of participants reported good mental health across both arms; however, the difference was statistically insignificant. The ICERs for good physical health at the health system and societal levels were below the one-time GDP per capita (Incremental Net Benefit = 77.49−83.03) but exceeded the opportunity cost CET. The ICERs for ART adherence at the health system and societal levels were above both CETs.

Conclusions

The results showed that the CAD model was cost-effective in reducing the decline in the physical health of people living with HIV during the COVID-19 pandemic in Cambodia when a less stringent threshold was used. Further investigations are required to ascertain the cost-effectiveness of the CAD model by factoring in the productivity gains within the health system.

Clinical Trial Number

NCT04766710

Abstract Image

查看原文本刊更多论文

柬埔寨为临床稳定型艾滋病毒感染者提供抗逆转录病毒治疗的社区模式的成本效益分析

在柬埔寨，所有艾滋病毒感染者中，89%知道自己的状况，89%正在接受抗逆转录病毒治疗（ART）， 87%的人在2023年抑制了病毒载量。2017年，国家艾滋病毒规划引入了多月配药模式，以减少对抗逆转录病毒治疗诊所的就诊，从而减轻艾滋病毒感染者和卫生机构的负担。一项准实验研究介绍了社区提供抗逆转录病毒药物（CAD）模式，即社区行动工作者（caw）向社区中的同龄人提供预先包装的抗逆转录病毒药物。本研究考察了CAD与MMD模型相比的成本效益。该研究在2021年至2023年期间进行，涉及CAD组的2040名稳定HIV感染者和MMD组的2049名稳定HIV感染者。基线和终点调查包括自我报告的抗逆转录病毒治疗依从性、生活质量、医疗和非医疗费用。意向治疗分析（ITTs）是根据参与者最初的治疗分配进行的，对最终失去随访的参与者进行了多次归因。从卫生系统和社会角度得出抗逆转录病毒治疗依从性和生活质量的增量成本效益比（ICERs）。成本效益阈值是一次性人均国内生产总值和机会成本。结果两组患者的ART依从性和身体健康状况均有所下降，其中CAD的下降幅度小于MMD (p值<；0.001)。同样，两组参与者中报告心理健康状况良好的比例都有所减少；然而，差异在统计上不显著。在卫生系统和社会层面，良好身体健康的ICERs低于一次性人均GDP（增量净效益= 77.49 - 83.03），但超过机会成本CET。在卫生系统和社会层面上，抗逆转录病毒治疗依从性的ICERs高于这两个ceet。结果表明，当使用较不严格的阈值时，CAD模型在减少柬埔寨COVID-19大流行期间艾滋病毒感染者身体健康状况下降方面具有成本效益。需要进一步调查，以确定CAD模型的成本效益，将卫生系统内的生产力收益考虑在内。临床试验编号NCT04766710

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

8.60

自引率

10.00%

发文量

186

审稿时长

>12 weeks

期刊介绍： The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.