Cost-effectiveness and feasibility of conditional economic incentives and motivational interviewing to improve HIV health outcomes of adolescents living with HIV in Anambra State, Nigeria

BMC Health Services Research

Charles Ebuka Okafor¹  Chinelo Janefrances Ofomata²  Maureen Ugonwa Anetoh²  Obinna Ikechukwu Ekwunife²  George Uchenna Eleje³  Prince Udegbunam Ele⁴  Stephen Okorafor Kalu⁵ 

[1] Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia;Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Nigeria;Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria;Division of Respiratory Medicine, Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria;Virology Laboratory, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria;

关键词: Cost-effectiveness;    Feasibility studies;    Incremental cost-effectiveness ratio;    HIV/AIDS;    Adherence;    Adolescents;    In-depth interviews;   

DOI  :  10.1186/s12913-021-06718-4

来源: Springer

【 摘 要 】

BackgroundIn sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria.MethodA cost-effectiveness analysis from the healthcare provider’s perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria.ResultThe ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients’ acceptance of the intervention was very high.ConclusionThe conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1–3 times per annum. Patients’ acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed.Trial registrationThis trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network (PACTR201806003040425).

【 授权许可】

CC BY