{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:07:40Z","timestamp":1791209260130,"version":"4.1.0"},"reference-count":34,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,23]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Differentiated service delivery (DSD) models have been introduced to optimise HIV care by tailoring services to patient needs, but evidence on their cost-effectiveness in Ethiopia is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the cost-effectiveness of DSD models for HIV care compared with standard of care (SOC) in North Wollo, Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Retrospective economic evaluation using bottom-up microcosting from a healthcare provider perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>One hospital and three health centres in North Wollo Zone, Ethiopia, from January 2024 to December 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>786 adults (\u226518 years) on antiretroviral therapy, including 393 receiving DSD (across nine models: 6-month multimonth dispensing, 3-month multimonth dispensing, appointment spacing, community antiretroviral therapy (ART) groups (CAG), FastTrack, maternal and child health, peer-led, adolescent groups and key population models) and 393 receiving SOC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Total annual cost per patient (USD), retention in care at 12 months (%) and incremental cost-effectiveness ratios (ICERs) expressed as cost per additional patient retained.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Statistical analysis<\/jats:title>\n                    <jats:p>Costs were annualised at a 3% discount rate. ICERs were calculated comparing each DSD model to SOC. Deterministic one-way sensitivity analysis (\u00b120% for medication cost and retention rate) assessed robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>SOC had the highest annual cost per patient (US$295) and lowest retention (76.6%). All DSD models were dominant (lower cost, higher retention) with negative ICERs. CAG was the most cost-effective (US$199 per patient; 93.0% retention; ICER \u20135.85), followed by FastTrack (US$212; 92.9%; \u20135.09) and adolescent groups (US$238; 90.5%; \u20134.10). Sensitivity analyses confirmed robustness; no scenario reversed dominance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>DSD models, particularly CAG, FastTrack and adolescent groups, provide more cost-effective HIV care than SOC in Ethiopia by achieving higher retention at lower costs. Scaling up these models could optimise resource allocation and reduce health system burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120948","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:35:26Z","timestamp":1791207326000},"page":"e120948","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness of differentiated HIV service delivery in North Wollo, Ethiopia: a retrospective study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9348-1488","authenticated-orcid":false,"given":"Tenaw Baye","family":"Tarekegn","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Woldia University, Woldia, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teshome Bitew","family":"Demelash","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Debre Berhan University, Debre Birhan, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"2026100506351660000_16.10.e120948.1","unstructured":"Unaids J . Fact sheet\u2014latest global and regional statistics on the status of the AIDS epidemic, 1. Geneva UNAIDS; 2022.1980\u20132015."},{"key":"2026100506351660000_16.10.e120948.2","doi-asserted-by":"crossref","first-page":"2290672","DOI":"10.1080\/20523211.2023.2290672","article-title":"Providing anti-retroviral treatment did not achieve the ambition of \u2018Joint United Nations program on HIV\/AIDS (UNAIDS) among HIV positive patient in Ethiopia\u2019: a systematic review and meta-analysis","volume":"17","author":"Melis","year":"2024","journal-title":"J Pharm Policy Pract"},{"key":"2026100506351660000_16.10.e120948.3","first-page":"1149","article-title":"ART Adherence Among People Living with HIV Seeking Services from Public Health Facilities in Western Ethiopia","volume":"13","author":"Tolossa","year":"2021","journal-title":"HIV AIDS (Auckl)"},{"key":"2026100506351660000_16.10.e120948.4","unstructured":"WHO Guidelines Approved by the Guidelines Review Committee . Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations \u2013 2016 update. Geneva World Health Organization, Copyright \u00a9 World Health Organization; 2016."},{"key":"2026100506351660000_16.10.e120948.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-023-09549-7","article-title":"Implementing six multi-month dispensing of antiretroviral therapy in Ethiopia: perspectives of clients and healthcare workers","volume":"23","author":"Mantell","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"2026100506351660000_16.10.e120948.6","doi-asserted-by":"crossref","first-page":"S339","DOI":"10.1097\/QAI.0000000000002195","article-title":"Cost of Differentiated HIV Antiretroviral Therapy Delivery Strategies in Sub-Saharan Africa: A Systematic Review","volume":"82 Suppl 3","author":"Roberts","year":"2019","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2026100506351660000_16.10.e120948.7","doi-asserted-by":"crossref","unstructured":"Grimsrud A , Barnabas RV , Ehrenkranz P , et al . Evidence for scale up: the differentiated care research agenda. 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Available: https:\/\/nbe.gov.et\/exchange\/"},{"key":"2026100506351660000_16.10.e120948.13","doi-asserted-by":"crossref","DOI":"10.1186\/s40945-022-00154-1","article-title":"Economic evaluation: a reader\u2019s guide to studies of cost-effectiveness","volume":"12","author":"Abbott","year":"2022","journal-title":"Arch Physiother"},{"key":"2026100506351660000_16.10.e120948.14","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1097\/QAI.0000000000003711","article-title":"Retention in HIV Care Still Matters: A Longitudinal Multisite Analysis","volume":"100","author":"Kay","year":"2025","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2026100506351660000_16.10.e120948.15","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e318273762f"},{"key":"2026100506351660000_16.10.e120948.16","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000462"},{"key":"2026100506351660000_16.10.e120948.17","doi-asserted-by":"crossref","unstructured":"Briggs AH , Claxton K , Sculpher MJ . Decision modelling for health economic evaluation. Oxford: Oxford University Press, 2006.","DOI":"10.1093\/oso\/9780198526629.001.0001"},{"key":"2026100506351660000_16.10.e120948.18","unstructured":"Drummond M , Sculpher MJ , Claxton K , et al . Methods for the economic evaluation of health care programmes. 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Encyclopedia of medical decision making. 2009.","DOI":"10.4135\/9781412971980"},{"key":"2026100506351660000_16.10.e120948.24","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25760","article-title":"Patient-incurred costs in a differentiated service delivery club intervention compared to standard clinical care in Northwest Tanzania","volume":"24","author":"Okere","year":"2021","journal-title":"J Int AIDS Soc"},{"key":"2026100506351660000_16.10.e120948.25","doi-asserted-by":"crossref","DOI":"10.1186\/s12981-026-00885-2","article-title":"Strategies to improve retention in care among people living with HIV at health facilities in Manaus, Brazil: insight from health care providers","volume":"23","author":"Salimo","year":"2026","journal-title":"AIDS Res Ther"},{"key":"2026100506351660000_16.10.e120948.26","doi-asserted-by":"crossref","DOI":"10.7448\/IAS.20.5.21647","article-title":"Effect of frequency of clinic visits and medication pick-up on antiretroviral treatment outcomes: a systematic literature review and meta-analysis","volume":"20","author":"Mutasa-Apollo","year":"2017","journal-title":"J Int AIDS Soc"},{"key":"2026100506351660000_16.10.e120948.27","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25232","article-title":"ART adherence and viral suppression are high among most non-pregnant individuals with early-stage, asymptomatic HIV infection: an observational study from Uganda and South Africa","volume":"22","author":"Haberer","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"2026100506351660000_16.10.e120948.28","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-026-37882-4","article-title":"Retention in care and viral suppression in people living with HIV and chronic hepatitis B in Maputo City, Mozambique: a prospective cohort study","volume":"16","author":"Chambal","year":"2026","journal-title":"Sci Rep"},{"key":"2026100506351660000_16.10.e120948.29","doi-asserted-by":"crossref","first-page":"e1298","DOI":"10.1016\/S2214-109X(22)00310-2","article-title":"Transmission reduction, health benefits, and upper-bound costs of interventions to improve retention on antiretroviral therapy: a combined analysis of three mathematical models","volume":"10","author":"Bershteyn","year":"2022","journal-title":"Lancet Glob Health"},{"key":"2026100506351660000_16.10.e120948.30","unstructured":"Kinuthia R . Evaluation of facility-based individual differentiated service delivery among people living with HIV in Nairobi, Kenya. 2022."},{"key":"2026100506351660000_16.10.e120948.31","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-025-13283-7","article-title":"Health provider perspectives on differentiated service delivery for HIV in Oyo state, Nigeria: exploring the experiences of service providers from a demand perspective","volume":"25","author":"Gift","year":"2025","journal-title":"BMC Health Serv Res"},{"key":"2026100506351660000_16.10.e120948.32","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-12087-8","article-title":"\u201cI don\u2019t know when he will be back\u201d: life-changing events challenge the community ART Group model- a qualitative research study, Tete, Mozambique","volume":"21","author":"Tarquino","year":"2021","journal-title":"BMC Public Health"},{"key":"2026100506351660000_16.10.e120948.33","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-026-14165-2","article-title":"Early impacts of PEPFAR funding freeze on HIV service delivery in mid-Western Uganda","volume":"26","author":"Zakumumpa","year":"2026","journal-title":"BMC Health Serv Res"},{"key":"2026100506351660000_16.10.e120948.34","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2025.1658229","article-title":"HIV response financing challenges in Sub-Saharan Africa: barriers to achieving the 95-95-95 UNAIDS targets","volume":"13","author":"Kulohoma","year":"2025","journal-title":"Front Public Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-120948","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:35:30Z","timestamp":1791207330000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-120948"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":34,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,5]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/bmjopen-2026-120948"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-120948","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]}}}