Cost and Outcomes of Routine HIV Care and Treatment: Public and Private Service Delivery Models Covering Low-Income Earners in South Africa

Background: While South Africa’s national HIV program is the largest in the world, it has yet to reach the UNAIDS 95-95-95 targets. To reach these targets the expansion of the HIV treatment program may be accelerated through the use private sector delivery models. This study identified three innovative non-governmental primary health care models providing HIV treatment, as well as two government primary health clinics that served similar populations. We estimated the resources used, and costs and outcomes of HIV treatment across these models. Methods: : We conducted a cost-outcomes analysis by collecting patient-level resource usage and treatment outcomes through retrospective medical record reviews and a bottom-up micro-costing from the provider perspective (public or private payer). Outcomes were based on whether the patient was still in care at the end of the follow up period and viral load status, if available. Results: : 376 patients were included across the five HIV treatment models. Across the three private sector models there are differences in the costs and outcomes of HIV treatment, but for two of the models they are within the range of the public sector primary health clinic results. The nurse-led model appears to be distinct from the others. Conclusion: The results suggest that it may be possible to expand the HIV treatment program by increasing access through private sector models. Depending on the model used it may be possible to achieve this at costs similar to those in the public sector while maintaining similar treatment outcomes.