40. Shop online and Click & Collect in any of our stores We conducted this review following the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.13. In comparison, 3 studies reported higher costs in the task-shifted model, with incremental costs ranging from $8 to $101 per patient per year (2018 USD).17,20,22 In 2 of these, additional start-up and supervision costs offset the lower per-visit personnel costs in the task-shifted model.17,20 In a randomized trial of nurse-led vs. doctor-led care in South Africa (Barton et al17), nurse-led care resulted in more frequent and longer clinical visits. A study by Bango et al30 of a Médecins Sans Frontières (MSF) program in South Africa described facility-based adherence clubs that included groups of 25–30 stable clients managed by a lay counselor. A pragmatic approach to monitor and evaluate implementation and impact of differentiated ART delivery for global and national stakeholders. Donor Government Funding for, 4. To find the exact cost for drugs prescribed by a healthcare provider, contact a local pharmacy. We extracted costs as implemented; modeled scenarios of staff substitution, price changes, or increased efficiency were excluded. By contrast, a 2012 study in Uganda of a nurse-driven streamlined ART delivery found costs (excluding drugs) of $889 (as observed, which included low volumes during study initiation) and $494 (at steady state, once full enrollment had been achieved) per patient per year.18 This study had high salaries due to the employment of research staff in the provision of care; modeled scenarios involving government personnel and increased efficiency projected costs as low as $236 (2018 USD, excluding ARVs) and $143 (without viral load testing).18. Antiretroviral drugs were the largest cost component at all six sites, comprising between 38% (site 5) and 84% (site 4) of the average cost per patient for the subset of the sample remaining in care one year after initiating ART. You may be trying to access this site from a secured browser on the server. The majority of studies reported care models for stable clients, but DART models are also needed for unstable patients who could benefit from more intensive care as well as for key populations who might benefit from alternative service delivery strategies.35 Several models did not report client eligibility criteria or client characteristics, which limits our understanding of the potential generalizability and scalability of the model. Of these, 4 models reported reduced costs in the DART model due to lower personnel costs, which were achieved through task shifting to a lower cadre in 2 models,16,21 reducing visit frequency in 1 model (Prust et al,23 multi-month prescribing), and both in 1 model (Prust et al,23 fast-track refills). to maintaining your privacy and will not share your personal information without
In conclusion, the majority of economic evidence for DART models comes from facility-based individual models. Additional economic evidence from community-based and group models is needed to better understand the scalability and sustainability of differentiated ART delivery. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing, 37. Antiretroviral drugs. Antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection is a treatment regimen used to reduce the amount of the virus in the body (viral load). We searched PubMed, Embase, Global Health, EconLit, and the grey literature for studies published between 2005 and 2019 that assessed the cost of DART. We included studies that collected primary costing data; modeling studies without an empirical costing component were excluded. 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