{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T09:25:49Z","timestamp":1793179549359,"version":"4.5.0"},"reference-count":61,"publisher":"Wiley","issue":"S4","license":[{"start":{"date-parts":[[2017,7,21]],"date-time":"2017-07-21T00:00:00Z","timestamp":1500595200000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of the International AIDS Society"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Introduction<\/jats:bold>: Rapid scale\u2010up of antiretroviral therapy (ART) in the context of financial and health system constraints has resulted in calls to maximize efficiency in ART service delivery. Adopting differentiated care models (DCMs) for ART could potentially be more cost\u2010efficient and improve outcomes. However, no study comprehensively projects the cost savings across countries. We model the potential reduction in facility\u2010level costs and number of health workers needed when implementing two types of DCMs while attempting to reach 90\u201090\u201090 targets in 38 sub\u2010Saharan African countries from 2016 to 2020.<\/jats:p><jats:p><jats:bold>Methods<\/jats:bold>: We estimated the costs of three service delivery models: (1) undifferentiated care, (2) differentiated care by patient age and stability, and (3) differentiated care by patient age, stability, key vs. general population status, and urban vs. rural location. Frequency of facility visits, type and frequency of laboratory testing, and coverage of community ART support vary by patient subgroup. For each model, we estimated the total costs of antiretroviral drugs, laboratory commodities, and facility\u2010level personnel and overhead. Certain groups under four\u2010criteria differentiation require more intensive inputs. Community\u2010based ART costs were included in the DCMs. We take into account underlying uncertainty in the projected numbers on ART and unit costs.<\/jats:p><jats:p><jats:bold>Results<\/jats:bold>: Total five\u2010year facility\u2010based ART costs for undifferentiated care are estimated to be US$23.33 billion (95% confidence interval [CI]: $23.3\u2013$23.5 billion). An estimated 17.5% (95% CI: 17.4%\u201317.7%) and 16.8% (95% CI: 16.7%\u201317.0%) could be saved from 2016 to 2020 from implementing the age and stability DCM and four\u2010criteria DCM, respectively, with annual cost savings increasing over time. DCMs decrease the full\u2010time equivalent (FTE) health workforce requirements for ART. An estimated 46.4% (95% CI: 46.1%\u201346.7%) fewer FTE health workers are needed in 2020 for the age and stability DCM compared with undifferentiated care.<\/jats:p><jats:p><jats:bold>Conclusions<\/jats:bold>: Adopting DCMs can result in significant efficiency gains in terms of reduced costs and health workforce needs, even with the costs of scaling up community\u2010based ART support under DCMs. Efficiency gains remained flat with increased differentiation. More evidence is needed on how to translate analyzed efficiency gains into implemented cost reductions at the facility level.<\/jats:p>","DOI":"10.7448\/ias.20.5.21648","type":"journal-article","created":{"date-parts":[[2017,5,15]],"date-time":"2017-05-15T20:34:08Z","timestamp":1494880448000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Can differentiated care models solve the crisis in HIV treatment financing? Analysis of prospects for 38 countries in sub\u2010Saharan Africa"],"prefix":"10.1002","volume":"20","author":[{"given":"Catherine","family":"Barker","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2753-5035","authenticated-orcid":false,"given":"Arin","family":"Dutta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Klein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,7,21]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Ambitious treatment targets: writing the final chapter on the AIDS epidemic","author":"Joint United Nations Programme on HIV\/AIDS","year":"2014"},{"key":"e_1_2_9_3_1","volume-title":"Guideline on when to start antiretroviral therapy and on pre\u2010exposure prophylaxis for HIV","author":"World Health Organization","year":"2015"},{"key":"e_1_2_9_4_1","volume-title":"Financing the response to HIV in low\u2010 and middle\u2010income countries: international assistance from Donor Governments in 2015","author":"Kates J","year":"2016"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70342-0"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-009656"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001907"},{"key":"e_1_2_9_8_1","first-page":"095646241666876","article-title":"Health facility factors and quality of services to prevent mother\u2010to\u2010child HIV transmission in C\u00f4te d'Ivoire, Kenya, and Mozambique","volume":"2","author":"Rustagi AS","year":"2016","journal-title":"Int J STD AIDS"},{"key":"e_1_2_9_9_1","unstructured":"United States Department of State. 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