Costs of integrating hypertension care into HIV care in rural East African clinics

Abstract

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.

Conflict of interest statement

DISCLOSURES/CONFLICTS OF INTEREST:

Related to work in this manuscript, all authors declare no conflicts of interests.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Figures

Figure 1.. Sensitivity Analysis of Variation in Costs of Hypertension Care

Sensitivity analysis showing costs for hypertension care to HIV-positive patients (panel A) and HIV-negative patients (panel B). For each, estimated average per-person per-year costs for hypertension care are shown in 2016 $USD for the observed (base case) scenario (blue bars), as well as a scenario in which cost components are reduced to 50% of observed (green bars), and a scenario where cost components are increased to 200% of observed (orange bars). For HIV-positive patients already receiving streamlined HIV care, the cost of hypertension care includes components of hypertension medicines and laboratory testing costs. For HIV-negative patients, cost of hypertension care additionally includes components of personnel effort, recurrent costs, and fixed costs.