- Shade, Starley B;
- Osmand, Thomas;
- Kwarisiima, Dalsone;
- Brown, Lillian B;
- Luo, Alex;
- Mwebaza, Betty;
- Mwesigye, Aine Ronald;
- Kwizera, Enos;
- Imukeka, Haawa;
- Mwanga, Florence;
- Ayieko, James;
- Owaraganise, Asiphas;
- Bukusi, Elizabeth A;
- Cohen, Craig R;
- Charlebois, Edwin D;
- Black, Douglas;
- Clark, Tamara D;
- Petersen, Maya L;
- Kamya, Moses R;
- Havlir, Diane V;
- Jain, Vivek
Objective
Sub-Saharan Africa faces twin epidemics of HIV and noncommunicable diseases including hypertension. Integrating hypertension care into chronic HIV care is a global priority, but cost estimates are lacking. In the SEARCH Study, we performed population-level HIV/hypertension testing, and offered integrated streamlined chronic care. Here, we estimate costs for integrated hypertension/HIV care for HIV-positive individuals, and costs for hypertension care for HIV-negative individuals in the same clinics.Design
Microcosting analysis of healthcare expenditures within Ugandan HIV clinics.Methods
SEARCH (NCT: 01864603) conducted community health campaigns for diagnosis and linkage to care for both HIV and hypertension. HIV-positive patients received hypertension/HIV care jointly including blood pressure monitoring and medications; HIV-negative patients received hypertension care at the same clinics. Within 10 Ugandan study communities during 2015-2016, we estimated incremental annual per-patient hypertension care costs using micro-costing techniques, time-and-motion personnel studies, and administrative/clinical records review.Results
Overall, 70 HIV-positive and 2355 HIV-negative participants received hypertension care. For HIV-positive participants, average incremental cost of hypertension care was $6.29 per person per year, a 2.1% marginal increase over prior estimates for HIV care alone. For HIV-negative participants, hypertension care cost $11.39 per person per year, a 3.8% marginal increase over HIV care costs. Key costs for HIV-positive patients included hypertension medications ($6.19 per patient per year; 98% of total) and laboratory testing ($0.10 per patient per year; 2%). Key costs for HIV-negative patients included medications ($5.09 per patient per year; 45%) and clinic staff salaries ($3.66 per patient per year; 32%).Conclusion
For only 2-4% estimated additional costs, hypertension care was added to HIV care, and also expanded to all HIV-negative patients in prototypic Ugandan clinics, demonstrating substantial synergy. Our results should encourage accelerated scale-up of hypertension care into existing clinics.