June 13, 2017

Cost modelling and evaluation outcomes for HIV Test & Start programmes

Written by EQUIP

This article originally appeared on EQUIP. Reposted with permission.

To help policy makers decide on the best routes to achieve the UNAIDS WHO  90-90-90 targets in their countries, EQUIP offers a range of innovative tools for cost modelling and evaluation outcomes for HIV Test & Start programmes. Dr. Brooke Nichols of HE2RO, part of the EQUIP health economics team, said at a recent meeting of EQUIP’s Technical Working Groups in Johannesburg: “Costing decisions are critical in determining when and how innovations get adopted, so cost modelling needs to be an integral part of what we offer as a consortium dedicated to rapid scale-up of innovations.”.

Cost analyses and cost effectiveness models can provide vital insights for decision-makers to better understand the cost implications of different treatment scale-up scenarios. Countries rely on accurate information on which to base resource allocation decisions that will affect health outcomes. EQUIP and USAID have supported the development of a costing tool to evaluate the cost and outcomes of healthcare programs such as Antiretroviral Therapy (ART). This tool, called the Healthcare Cost and Outcomes Model (HCOM), facilitates detailed cost estimates and analysis of how costs vary with patient outcomes.

The tool has already been used to assess the cost-effectiveness of task shifting in the care of stable ART patients to nurses in South Africa, and to compare the costs of providing ART at primary healthcare clinics and hospital clinics. Self-testing, adherence clubs and community-based adherence clubs are soon to undergo cost-effectiveness analysis using HCOM.

Two other costing tools have been implemented as part of EQUIP’s portfolio of resources to support country capacity; one is used for the costing for Test & Start that enable governments, PEPFAR, and partners to understand the long-term cost implications and potential health impacts of rapidly scaling-up treatment access under alternative scenarios. The tool has already been used in Zambia and Uganda to calculate the additional resources that would be needed to achieve the most substantial reduction in new infections and deaths.

The third costing tool is used for the analyses of viral load scale-up, critical for achieving the third UNAIDS WHO 90 goal – viral suppression in at least 90% of people on ART. This tool helps countries analyse the costs of different ways of organising viral load monitoring, from sample transport and tracking systems to the impact of point-of-care viral load on retention and suppression. The tool also includes a dynamic transmission model to assess the impact of the time taken to act on viral load results on long-term HIV transmission.