Comparison of costs of four alternative ways of implementing a patient retention strategy in the Anti-Retroviral Therapy (ART) programme in Ebonyi State Nigeria.

Abstract Background: Identifying cost-effective interventions for retention in care is important, especially with the growing need for country ownership of the HIV/AIDS response and for efficient allocation of health resources. The goal of this study was to assess the cost and cost-effectiveness ratio of four patient retention strategies in Ebonyi State ART programme. Methods: This was a cross-sectional comparative study. The sample size was 893 patients treated in 17 comprehensive HIV care facilities. The programme design for retention in care was enhanced patient contact through intensive HIV education at initiation of therapy, routine adherence counseling during scheduled 3-monthly clinic visits for stable patients, and phone calls and home visits for defaulting patients. The study assessed the cost of performing these tasks by either formal health care workers only (group A facilities), expert patients called Treatment Support Specialists (TSS) (Group B and C) or a combination of formal health worker and TSS (group D). Data on patient retention was extracted from patient treatment cards; Data on the retention activities in each facility and the cost of implementing them was extracted through programme document review, supplemented by data from semi-structured questionnaire interviews of programme managers and health facility project coordinators. The direct micro-costing method was used to estimate the unit cost of retention activity. Retention rates and cost effectiveness ratios were computed and compared. Results: The retention rates at the end of 12 months follow up were 79.5%, 92.1%, 95.2% and 97.1% respectively in the group A, B, C, and D facilities respectively. The total annual cost of the programme was ten million five hundred and eighty- two thousand Nigerian Naira (10, 582, 800.00 {$25,011.6}). The average cost per patient were 21443.75 (~ $68.40), 9309.82 ($29.7), 13,885.33 ($44.3), 14,863.64 ($47.4) in groups A-D respectively. Conclusion: The patient retention strategies in which treatment support specialist (TSS) performed the patient retention strategy tasks achieved a higher retention rates and cost-effectiveness ratios than that where only formal health care workers (FHCW) alone or in combination with the TSS performed the tasks. However, the cost of the retention activities was feasible.