{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T10:46:28Z","timestamp":1778755588055,"version":"3.51.4"},"reference-count":40,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T00:00:00Z","timestamp":1728432000000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-046299"],"award-info":[{"award-number":["INV-046299"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,8,29]]},"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>In high HIV-burden countries like Uganda, financing and resource allocation for HIV services have rapidly evolved. This study aimed to employ time-driven activity-based costing (TDABC) to examine the allocation of resources and associated costs for HIV care throughout the country.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This study was conducted at 31 health facilities throughout Uganda: 16 level III health centres, 10 level IV health centres and 5 district hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1119 persons receiving HIV services in 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted TDABC to quantify costs, resource consumption and duration of service provision associated with antiretroviral therapy, prevention of mother-to-child transmission, HIV counselling and testing (HCT), voluntary medical male circumcision (VMMC) and pre-exposure prophylaxis. We also quantified disparities in resource consumption according to client-level and facility-level characteristics to examine equity. Fixed-effects multivariable regression analyses were employed to inspect factors associated with service costs and provider-client interaction time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean cost of services ranged from US$8.18 per visit for HCT to US$32.28 for VMMC. In terms of disparities, those in the Western region received more provider time during visits compared with other regions (35 more minutes, p&lt;0.001); and those receiving care at private facilities received more provider time compared with public facilities (13 more minutes, p=0.02); and those at level IV health centres received more time compared with those at level III (12 more minutes, p=0.01). Absent consumables, services for older adults (US$2.28 higher, p=0.02), those with comorbidities (US$1.44 higher, p&lt;0.001) and those living in the Western region (US$2.88 higher, p&lt;0.001) were more expensive compared with younger adults, those without comorbidities and those in other regions, respectively. Inclusive of consumables, services were higher-cost for individuals in wealthier households (US$0.83 higher, p=0.03) and those visiting level IV health centres (US$3.41 higher, p=0.006) compared with level III.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Costs and resources for HIV care vary widely throughout Uganda. This variation requires careful consideration: some sources of variation may be indicative of vertical and horizontal equity within the health system, while others may be suggestive of inequities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-082062","type":"journal-article","created":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T11:50:19Z","timestamp":1728474619000},"page":"e082062","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Costs and resource distribution of direct services for HIV in Uganda"],"prefix":"10.1136","volume":"14","author":[{"given":"Elizabeth","family":"Ekirapa","sequence":"first","affiliation":[{"name":"Makerere University School of Public Health, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Jordan","sequence":"additional","affiliation":[{"name":"Brandeis University, Waltham, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thuong","family":"Nong","sequence":"additional","affiliation":[{"name":"Brandeis University, Waltham, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tozoe Elaine","family":"Marton","sequence":"additional","affiliation":[{"name":"Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hudson","family":"Balidawa","sequence":"additional","affiliation":[{"name":"Ministry of Health, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5688-5835","authenticated-orcid":false,"given":"Richard","family":"Ssempala","sequence":"additional","affiliation":[{"name":"Economic Theory and Analysis, Makerere University School of Economics, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Ssebagereka","sequence":"additional","affiliation":[{"name":"Makerere University School of Public Health, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Kagaayi","sequence":"additional","affiliation":[{"name":"Makerere University School of Public Health, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allyala","family":"Nandakumar","sequence":"additional","affiliation":[{"name":"Brandeis University, Waltham, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0073-0348","authenticated-orcid":false,"given":"Ryan K","family":"McBain","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,10,9]]},"reference":[{"key":"2025121223091587000_14.10.e082062.1","unstructured":"University of Chicago . 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