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HIV Care Retention and Cost Analysis in Multi-Month ART Dispensing: A Randomized Controlled Trial in China
Wenqi Shang1, Yanyan Zhu1, Ying He1
1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Prevention and Treatment, National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, China Medical University, Shenyang, China.
Six-month multi-month dispensing (MMD) of antiretroviral therapy (ART) is as effective as 3-month dispensing for HIV treatment retention. This approach significantly reduces patient costs and clinic visits, demonstrating cost-effectiveness.
Area of Science:
- Public Health
- Infectious Disease Management
- Health Economics
Background:
- Multi-month dispensing (MMD) offers a differentiated service delivery model for HIV care, potentially reducing patient burdens.
- Previous studies suggest MMD can decrease clinic visit frequency, waiting times, and travel expenses for stable patients on antiretroviral therapy (ART).
- Evaluating the impact of extended MMD schedules on retention and cost-effectiveness in diverse healthcare settings is crucial.
Purpose of the Study:
- To assess the impact of 6-month MMD of ART on patient retention compared to standard 3-month dispensing.
- To conduct a cost analysis of 6-month MMD versus 3-month dispensing for HIV treatment in China.
- To determine if 6-month MMD meets non-inferiority criteria for treatment retention and offers economic benefits.
Main Methods:
- A randomized, non-blind, non-inferiority study was conducted with 1588 participants over 18 months.
- Participants were assigned to either 3-month or 6-month ART dispensing groups.
- Key outcomes included treatment retention rates, virological suppression (<50 copies/mL), and treatment costs, analyzed using Cox regression and descriptive statistics.
Main Results:
- No significant difference in treatment retention rates at 18 months between the 3-month (94.9%) and 6-month (94.2%) dispensing groups (non-inferiority demonstrated).
- Viral suppression rates were similarly high in both groups (94.9% vs. 94.2%).
- The 6-month MMD group experienced fewer annual outpatient visits (3 vs. 5), resulting in a 27.7% reduction in total treatment costs and a 16.7% decrease in work value loss.
Conclusions:
- Six-month MMD of ART is a non-inferior strategy for maintaining patient retention in HIV care.
- MMD significantly reduces patient costs associated with clinic visits and associated expenses.
- The findings support 6-month MMD as a cost-effective model for HIV treatment delivery.
