Integrated HIV, Diabetes, and Hypertension Services Cut Costs for Providers, Patients

Integration of ambulatory health services for the management of human immunodeficiency virus (HIV), diabetes, and hypertension substantially reduced costs for clinics and patients in low-income countries, according to an article published in BMC Medicine.

“In this cohort study, we have demonstrated that one-stop treatment of comorbidities is likely worthwhile and an efficient strategy enhancing financial equity in service provision for people with multiple conditions in sub-Saharan Africa settings,” researchers wrote.

The study enrolled 2273 participants with HIV, diabetes, or hypertension—or combinations of the three conditions—in primary health clinics in Tanzania and Uganda. Participants were followed for up to 12 months.

The retention rate after 12 months of service was 84.1%, researchers reported. Just over one-quarter of patients had two or three of the conditions, while about three-quarters had one condition. However, 84 participants acquired a second or third condition during the study.

Monthly health clinic costs for managing patients with two of the conditions under the integrated care model were 34.4% lower compared with managing two conditions separately in two different participants, according to the study. Monthly costs of managing a patient with all three conditions was 48.8% lower than if they were managed separately in three different participants.

Out-of-pocket costs for patients averaged $7.33 per visit and included consultation costs, transport costs, medication costs, lost labor, and other costs, researchers reported.

“Participants with multiple conditions made one trip every 1 to 3 months to a health facility under the integrated care model. This is more convenient and less costly than two or three visits as is the case across sub-Saharan Africa now, if participants are treated in vertical stand-alone clinicals for each condition,” researchers pointed out. “This results in huge out-of-pocket savings for them and reduced duplication of clinical management activities at the health service.”

Reference:
Shiri T, Birungi J, Garrib AV, et al. Patient and health provider costs of integrated HIV, diabetes and hypertension ambulatory health services in low-income settings—an empirical socio-economic cohort study in Tanzania and Uganda. BMC Med. 2021 Sep 10;19(1):230. doi:10.1186/s12916-021-02094-2