The effectiveness and cost-effectiveness of community-based support for adolescents receiving antiretroviral treatment : an operational research study in South Africa

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dc.contributor.authorFatti, Geoffreyen_ZA
dc.contributor.authorJackson, Debraen_ZA
dc.contributor.authorGoga, Ameena E.en_ZA
dc.contributor.authorShaikh, Najmaen_ZA
dc.contributor.authorEley, Brianen_ZA
dc.contributor.authorNachega, Jean B.en_ZA
dc.contributor.authorGrimwood, Ashrafen_ZA
dc.date.accessioned2020-04-25T12:27:13Z
dc.date.available2020-04-25T12:27:13Z
dc.date.issued2018
dc.descriptionCITATION: Fatti, G., et al. 2018. The effectiveness and cost-effectiveness of community-based support for adolescents receiving antiretroviral treatment : an operational research study in South Africa. Journal of the International AIDS Society, 21(1):e25041, doi:10.1002/jia2.25041.
dc.descriptionThe original publication is available at https://onlinelibrary.wiley.com
dc.description.abstractIntroduction: Adolescents and youth receiving antiretroviral treatment (ART) in sub-Saharan Africa have high attrition and inadequate ART outcomes, and evaluations of interventions improving ART outcomes amongst adolescents are very limited. Sustainable Development Goal (SDG) target 3c is to substantially increase the health workforce in developing countries. We measured the effectiveness and cost-effectiveness of community-based support (CBS) provided by lay health workers for adolescents and youth receiving ART in South Africa. Methods: A retrospective cohort study including adolescents and youth who initiated ART at 47 facilities. Previously unemployed CBS-workers provided home-based ART-related education, psychosocial support, symptom screening for opportunistic infections and support to access government grants. Outcomes were compared between participants who received CBS plus standard clinic-based care versus participants who received standard care only. Cumulative incidences of all-cause mortality and loss to follow-up (LTFU), adherence measured using medication possession ratios (MPRs), CD4 count slope, and virological suppression were analysed using multivariable Cox, competing-risks regression, generalized estimating equations and mixedeffects models over five years of ART. An expenditure approach was used to determine the incremental cost of CBS to usual care from a provider perspective. Incremental cost-effectiveness ratios were calculated as annual cost per patient-loss (through death or LTFU) averted. Results: Amongst 6706 participants included, 2100 (31.3%) received CBS. Participants who received CBS had reduced mortality, adjusted hazard ratio (aHR) = 0.52 (95% CI: 0.37 to 0.73; p < 0.0001). Cumulative LTFU was 40% lower amongst participants receiving CBS (29.9%) compared to participants without CBS (38.9%), aHR = 0.60 (95% CI: 0.51 to 0.71); p < 0.0001). The effectiveness of CBS in reducing attrition ranged from 42.2% after one year to 35.9% after five years. Virological suppression was similar after three years, but after five years 18.8% CBS participants versus 37.2% non-CBS participants failed to achieve viral suppression, adjusted odds ratio = 0.24 (95% CI: 0.06 to 1.03). There were no significant differences in MPR or CD4 slope. The cost of CBS was US$49.5/patient/year. The incremental cost per patient-loss averted was US$600 and US$776 after one and two years, respectively. Conclusions: CBS for adolescents and youth receiving ART was associated with substantially reduced patient attrition, and is a low-cost intervention with reasonable cost-effectiveness that can aid progress towards several health, economic and equality- related SDG targets.en_ZA
dc.description.urihttps://onlinelibrary.wiley.com/doi/10.1002/jia2.25041
dc.description.versionPublisher's version
dc.format.extent12 pages
dc.identifier.citationFatti, G., et al. 2018. The effectiveness and cost-effectiveness of community-based support for adolescents receiving antiretroviral treatment : an operational research study in South Africa. Journal of the International AIDS Society, 21(1):e25041, doi:10.1002/jia2.25041
dc.identifier.issn1758-2652 (online)
dc.identifier.otherdoi:10.1002/jia2.25041
dc.identifier.urihttp://hdl.handle.net/10019.1/107728
dc.language.isoen_ZAen_ZA
dc.publisherWiley Open Access
dc.rights.holderAuthors retain copyright
dc.subjectAntiretroviral agentsen_ZA
dc.subjectHIV-positive youth -- Medical care -- Cost effectiveness -- South Africaen_ZA
dc.subjectHIV-positive youth -- Services for -- Cost effectiveness -- South Africaen_ZA
dc.subjectCommunity-based health services -- Cost effectivenessen_ZA
dc.subjectHIV infections -- Treatment -- South Africaen_ZA
dc.titleThe effectiveness and cost-effectiveness of community-based support for adolescents receiving antiretroviral treatment : an operational research study in South Africaen_ZA
dc.typeArticleen_ZA
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