{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T08:25:48Z","timestamp":1773735948607,"version":"3.50.1"},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,4,10]],"date-time":"2021-04-10T00:00:00Z","timestamp":1618012800000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["OAA\u2010A\u201015\u201000070"],"award-info":[{"award-number":["OAA\u2010A\u201015\u201000070"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. Intern. AIDS Soc."],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Lesotho, the country with the second\u2010highest HIV\/AIDS prevalence (23.6%) in the world, has made considerable progress towards achieving the \u201c95\u201095\u201095\u201d UNAIDS targets, but recent success in improving treatment access to all known HIV positive individuals has severely strained existing healthcare infrastructure, financial and human resources. Lesotho also faces the challenge of a largely rural population who incur a significant time and financial burden to visit healthcare facilities. Using data from a cluster\u2010randomized non\u2010inferiority trial conducted between August 2017 and July 2019, we evaluated costs to providers and costs to patients of community\u2010based differentiated models of multi\u2010month delivery of antiretroviral therapy (ART) in Lesotho.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The trial of multi\u2010month dispensing compared 12\u2010month retention in care among three arms: conventional care, which required quarterly facility visits and ART dispensation (3MF); three\u2010month community adherence groups (CAGs) (3MC) and six\u2010month community ART distribution (6MCD). We first estimated the average total annual cost of providing HIV care and treatment followed by the total cost per patient retained 12 months after entry for each arm, using resource utilization data from the trial and local unit costs. We then estimated the average annual cost to patients in each arm with self\u2010reported questionnaire data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The average total annual cost of providing HIV care and treatment per patient was the highest in the 3MF arm ($122.28, standard deviation [SD] $23.91), followed by 3MC ($114.20, SD $23.03) and the 6MCD arm ($112.58, SD $21.44). Per patient retained in care, the average provider cost was $125.99 (SD $24.64) in the 3MF arm and 6% to 8% less for the other two arms ($118.38, SD $23.87 and $118.83, SD $22.63 for the 3MC and 6MCD respectively). There was a large reduction in patient costs for both differentiated service delivery arms: from $44.42 (SD $12.06) annually in the 3MF arm to $16.34 (SD $5.11) annually in the 3MC (63% reduction) and $18.77 (SD $8.31) annually in 6MCD arm (58% reduction).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Community\u2010based, multi\u2010month models of ART in Lesotho are likely to produce small cost savings to treatment providers and large savings to patients in Lesotho. Patient cost savings may support long\u2010term adherence and retention in care.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25692","type":"journal-article","created":{"date-parts":[[2021,4,10]],"date-time":"2021-04-10T10:32:27Z","timestamp":1618050747000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Economic evaluation of differentiated service delivery models for HIV treatment in Lesotho: costs to providers and patients"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4682-4999","authenticated-orcid":false,"given":"Brooke E","family":"Nichols","sequence":"first","affiliation":[{"name":"Department of Global Health School of Public Health Boston University Boston MA USA"},{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Refiloe","family":"Cele","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nkgomeleng","family":"Lekodeba","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Betty","family":"Tukei","sequence":"additional","affiliation":[{"name":"Right to Care Centurion South Africa"},{"name":"EQUIP Lesotho Maseru Lesotho"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicoletta","family":"Ngorima\u2010Mabhena","sequence":"additional","affiliation":[{"name":"Kheth\u2019Impilo AIDS Free Living Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Appolinaire","family":"Tiam","sequence":"additional","affiliation":[{"name":"Elizabeth Glaser Pediatric AIDS Foundation USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thapelo","family":"Maotoe","sequence":"additional","affiliation":[{"name":"Right to Care Centurion South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makatleho Veronica","family":"Sejana","sequence":"additional","affiliation":[{"name":"EQUIP Lesotho Maseru Lesotho"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iyiola O","family":"Faturiyele","sequence":"additional","affiliation":[{"name":"Department of Epidemiology &amp; Biostatistics School of Public Health University of the Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Chasela","sequence":"additional","affiliation":[{"name":"Right to Care Centurion South Africa"},{"name":"USAID Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sydney","family":"Rosen","sequence":"additional","affiliation":[{"name":"Department of Global Health School of Public Health Boston University Boston MA USA"},{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6467-662X","authenticated-orcid":false,"given":"Geoffrey","family":"Fatti","sequence":"additional","affiliation":[{"name":"Kheth\u2019Impilo AIDS Free Living Cape Town South Africa"},{"name":"Division of Epidemiology and Biostatistics Department of Global Health Faculty of Medicine and Health Sciences Stellenbosch University Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,4,10]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"UNAIDS.UNAIDS Country report: Lesotho.2019[cited 2019 Oct 5]. Available from:https:\/\/www.unaids.org\/en\/regionscountries\/countries\/lesotho"},{"key":"e_1_2_10_3_1","volume-title":"Consolidated guidelines for the use antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach","author":"WHO","year":"2016"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.20.5.21650"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000002737"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000728"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.16.1.18055"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/2325958218774775"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-018-5961-0"},{"key":"e_1_2_10_10_1","unstructured":"TukeiBB FattiG TiamA et al.Community\u2010based multimonth dispensing of ART: a cluster randomised trial in Lesotho. 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