{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T03:41:40Z","timestamp":1752550900213,"version":"3.41.2"},"reference-count":72,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>In Cambodia, of all people living with HIV, 89% knew their status, 89% were receiving antiretroviral therapy (ART) and 87% had their viral load suppressed in 2023. In 2017, the national HIV programme introduced the multi\u2010month dispensing (MMD) model to reduce visits to ART clinics, thereby reducing the burden on people living with HIV and health facilities. A quasi\u2010experimental study introduced the community ART delivery (CAD) model, where community action workers (CAWs) delivered pre\u2010packaged antiretrovirals to their peers in the community. This study examined the cost\u2010effectiveness of the CAD compared to the MMD model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study was conducted between 2021 and 2023 and involved 2040 stable people living with HIV in the CAD arm and 2049 in the MMD arm. Baseline and endline surveys included self\u2010reported ART adherence, quality of life, and medical and non\u2010medical expenses. Intention\u2010to\u2010treat analyses (ITTs) were conducted based on participants\u2019 original treatment assignment, with multiple imputations performed for participants lost to follow\u2010up at the endline. Incremental cost\u2010effectiveness ratios (ICERs) on ART adherence and quality of life were generated using health system and societal perspectives. Cost\u2010effectiveness thresholds (CETs) were one\u2010time gross domestic product (GDP) per capita and opportunity cost.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both arms observed a decline in ART adherence and good physical health, with a decline in CAD less than in the MMD (<jats:italic>p<\/jats:italic>\u2010value &lt;\u00a00.001). Similarly, a reduced proportion of participants reported good mental health across both arms; however, the difference was statistically insignificant. The ICERs for good physical health at the health system and societal levels were below the one\u2010time GDP per capita (Incremental Net Benefit = 77.49\u221283.03) but exceeded the opportunity cost CET. The ICERs for ART adherence at the health system and societal levels were above both CETs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The results showed that the CAD model was cost\u2010effective in reducing the decline in the physical health of people living with HIV during the COVID\u201019 pandemic in Cambodia when a less stringent threshold was used. Further investigations are required to ascertain the cost\u2010effectiveness of the CAD model by factoring in the productivity gains within the health system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Number<\/jats:title><jats:p>NCT04766710<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26476","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T22:13:08Z","timestamp":1751926388000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost\u2010effectiveness analysis of a community\u2010based model for delivery of antiretroviral therapy to people with clinically stable HIV in Cambodia"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6349-3856","authenticated-orcid":false,"given":"Lo Yan Esabelle","family":"Yam","sequence":"first","affiliation":[{"name":"Saw Swee Hock School of Public Health National University of Singapore and National University Health System  12 Science Drive 2, #10\u201001 Singapore 119260 Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pheak","family":"Chhoun","sequence":"additional","affiliation":[{"name":"KHANA Center for Population Health Research KHANA  Phnom Penh Cambodia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziya","family":"Tian","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health National University of Singapore and National University Health System  12 Science Drive 2, #10\u201001 Singapore 119260 Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michiko","family":"Nagashima\u2010Hayashi","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health National University of Singapore and National University Health System  12 Science Drive 2, #10\u201001 Singapore 119260 Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Zahari","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health National University of Singapore and National University Health System  12 Science Drive 2, #10\u201001 Singapore 119260 Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sovannary","family":"Tuot","sequence":"additional","affiliation":[{"name":"KHANA Center for Population Health Research KHANA  Phnom Penh Cambodia"},{"name":"Department of Community and Global Health Graduate School of Medicine University of Tokyo  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4850-2176","authenticated-orcid":false,"given":"Sovannarith","family":"Samreth","sequence":"additional","affiliation":[{"name":"National Center for HIV\/AIDS, Dermatology and STD, Ministry of Health  Phnom Penh Cambodia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bora","family":"Ngauv","sequence":"additional","affiliation":[{"name":"National Center for HIV\/AIDS, Dermatology and STD, Ministry of Health  Phnom Penh Cambodia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vichea","family":"Ouk","sequence":"additional","affiliation":[{"name":"National Center for HIV\/AIDS, Dermatology and STD, Ministry of Health  Phnom Penh Cambodia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiesha","family":"Prem","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health National University of Singapore and National University Health System  12 Science Drive 2, #10\u201001 Singapore 119260 Singapore"},{"name":"London School of Hygiene and Tropical Medicine University of London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3045-5386","authenticated-orcid":false,"given":"Siyan","family":"Yi","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health National University of Singapore and National University Health System  12 Science Drive 2, #10\u201001 Singapore 119260 Singapore"},{"name":"KHANA Center for Population Health Research KHANA  Phnom Penh Cambodia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"volume-title":"Global AIDS Monitoring 2019: Country Progress Report\u2014Cambodia","year":"2019","key":"e_1_2_11_2_1"},{"volume-title":"Cambodia: HIV Country Profile 2024","year":"2024","key":"e_1_2_11_3_1"},{"issue":"3","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0121461","article-title":"AIDS\u2010related stigma and mental disorders among people living with 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