Related Experiment Video
Updated: Mar 14, 2026
Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
Cost-effectiveness of implementing the chronic care model for HIV care in Uganda
Edward I Broughton1,2, Martin Muhire3, Esther Karamagi4
1R&E director, University Research Co., LLC.
Objective:
The chronic care model (CCM) is an integrated, population-based approach for treating those with chronic diseases that involves patient self-management, delivery system design and decision support for clinicians to ensure evidence-based care. We sought to determine effectiveness and cost-effectiveness of implementing the CCM for HIV care in Uganda.
Design:
This controlled, pre/post-intervention study used difference-in-differences analysis to evaluate effectiveness of the CCM to improve patient adherence to antiretroviral therapy (ART) and CD4 counts.
Setting:
One district hospital and two smaller facilities each in one intervention and one control district in Uganda.
Participants:
About 46 randomly sampled patients receiving HIV services at three control sites and 56 patients from three intervention sites.
Intervention:
Two group training sessions and monthly coaching visits from improvement experts over 1 year, implementing the CCM.
Main Outcome Measure(S):
Patient adherence to ART prescriptions (pill counts) and CD4 counts were measured at baseline and en dline.
Results:
The odds of increased CD4 in the intervention group was 3.2 times higher than controls (P = 0.022). Clinician-reported ART adherence was 60% (P = 0.001) higher in the intervention group. The intervention cost $11 740 and served 7016 patients ($1.67 per patient). Incremental cost-effectiveness ratios of the intervention compared to business-as-usual was $6.90 per additional patient with improved CD4 and $3.40 per additional ART patient with stable or improved adherence.
Conclusion:
For modest expenditure, it is possible to improve indicators of HIV care quality using the CCM. We recommended implementing the CCM in Uganda; it may be applicable in similar settings in other countries.
Related Concept Videos
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:28Chronic Kidney Disease III: Interprofessional Care
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
01:10Retrovirus Life Cycles
01:30Primary Healthcare Services
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
01:18Chronic Kidney Disease IV: Nursing Management