EQUIP: Economic evaluations of differentiated models of service delivery

Countries around the world have adopted the UNAIDS global “90-90-­90” targets for HIV management: 90% of those infected know their status; 90% of those who know that they are infected are on antiretroviral therapy (ART); and 90% of those on ART are virally suppressed. EQUIP is a global cooperative agreement between USAID and a consortium of African organizations to provide support and technical assistance to USAID countries to foster achievement of 90-­90-90. BUSPH is a supporting partner in the EQUIP consortium, with a focus on economic evaluation and other data analysis. Projects including measuring and modeling the cost-­effectiveness of different approaches to ART service delivery; national­-level modeling of the impact and budgetary requirements of meeting the targets; and research on viral load testing scaleup, integrated treatment of HIV and HCV, and other related topics.

Under EQUIP, we conducted several evaluations of the costs of differentiated models of service delivery (DSD) for HIV treatment. In Zambia and Uganda, these evaluations required obtaining primary, patient-level data from a wide range of implementing partners, which are nongovernmental organizations that help national ministries of health to implement their policies, often with funding from PEPFAR or the Global Fund. We estimated patient outcomes, cost per patient treated and per patient successfully treated, and cost-effectiveness of alternative models for managing stable ART patients in these two countries.

In Lesotho and Zimbabwe, where the evaluations were carried out by another EQUIP partner, we generated the cost estimates using data provided to us. Finally, in Malawi and Zambia, we served as co-investigators for the INTERVAL trial, which assessed the effectiveness and cost of six-month dispensing of antiretroviral medications.

Boston University investigators Sydney Rosen (PI), Brooke Nichols, Lawrence Long, Matthew Fox
Partner investigators Uganda:  Health Net Consulting, Teresa Guthrie

Zambia: Right to Care

Malawi (Interval): Partners in Hope

Countries Zambia, Uganda, Lesotho, Malawi, Zimbabwe
Project period 2015-2020
Funder USAID
Project website www.equiphealth.org
Contacts Brooke Nichols (Zambia, Lesotho, Zimbabwe); Lawrence Long (Uganda); Sydney Rosen (INTERVAL)

Publications and other documents

Do DSD models for HIV treatment save money for health systems?  Primary data from multiple EQUIP evaluations of DSD models. AMBIT/CQUIN/EQUIP webinar, September 22, 2020.  Slides can be downloaded here.

Hoffman RM, Moyo C, Balakasi K, Siwale Z, Hubbard J, Bardon A, Fox MP, Kakwesa G, Kalua T, Haambokoma M, Dovel K, Campbell P, Tseng C, Pisa TP, Cele R, Gupta S, Benade M, Long L, Xulu T, Sanne I, Rosen S. Multi-month dispensing of up to six months of antiretroviral therapy in Malawi and Zambia: Results of a cluster-randomized trial. Lancet Global Health 2021 May;9(5):e628-e638.

Nichols BE, Cele R, Lekodeba N, Tukei B, Norima-Mabhena N, Tiam A, Maotoe T, Sejana MV, Faturiyele I, Chasela C, Rosen S, Fatti G. Economic evaluation of a cluster randomized trial of differentiated service delivery models for HIV treatment in Lesotho: costs to providers and patients. J Int AIDS Soc 2021; 24: e25692.

Nichols BE, Cele R, Jamieson L, Long L, Siwale Z, Banda P, Moyo C, Rosen S. Community-based service delivery of HIV treatment in Zambia: costs and outcomes. AIDS 2021:299-306. PMID: 33170578

Hoffman R, Bardon A, Rosen S, Fox MP, Kalua T, Xulu T, Taylor A, Sanne I. Varying intervals of antiretroviral medication dispensing to improve outcomes for HIV patients (The INTERVAL Study): study protocol for a randomized controlled trial. Trials 2017; 18(1):476. PMID: 29029644

Nichols B, Fatti G, Cele R, Lekodeba N, Maotoe T, Sejana MV, Chasela C, Faturiyele I, Tukei B, Rosen S. Economic evaluation of differentiated service delivery models for ART service delivery from a cluster-randomized trial in Lesotho: Cost to provider and cost to patient. Abstract PEE1626, AIDS 2020, July 6-10, 2020. (Poster can be requested from brooken@bu.edu).