AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #284 - Costing the National Antiretroviral Therapy Program in Botswana
Authors: Presenting Author: Dr. Richard Marlink - Harvard School of Public Health
Additional Authors: Dr. Mansour Farahani, Ms. Danae Roumis, Ms. Elizabeth Jackson, Mr. Godfrey Musuka, Dr. Themba Moeti, Dr. Ava Avalos, Ms. Elsie Hulela, Mr. Tim Chadborn, Dr. Khumo Seipone, Dr. Richard Marlink,
Aim: Background: The Botswana government has demonstrated clear and solid commitment to providing antiretroviral treatment (ART) to people living with HIV/AIDS. The national HIV/AIDS treatment program, also called Masa, currently provides ART to more than 147,000 people living with HIV/AIDS in the country. Objective: The objective of the costing exercise was to estimate the cost of continuing to provide, and expand, ART in the public sector in Botswana through the year 2015. The findings will provide program planners and policymakers with a frame of reference when scaling up ART programs in the public sector.
Method / Issue: Methods: We developed models for the care and treatment of the people living with HIV/AIDS enrolled in the Masa program and accounted for both adult and pediatric patients. We collected demographic and epidemiologic data from a number of sources including the Botswana Ministry of Health and Central Statistics Office, the UN Population Division, the World Bank, and UNICEF. To project the cost of the Masa program through 2015, we focused on the principal cost drivers in Masa including ARV drugs, laboratory tests, human resources, diagnosis and treatment of opportunistic infections, and infrastructure. Human resource and infrastructure cost inputs were adjusted for percentage increases over this time period. The expected increase in patient enrollment in Masa through 2015 was also estimated. Additionally, we allowed for changes in the cost of medications to the government due to changes in donation levels of medications over time.
Results / Comments: Findings: We estimate that the number of patients will increase to about 250,000 in 2015, if more than 40% of the untested population is tested, and current overall enrollment rates are maintained. Due to the current drug donation agreement in Botswana, in 2010 the government paid an average of 357 USD per patient on ART. We project this will increase to 469 USD per patient in 2015 due to the growing number of patients expected to be on the new first-line ART regimens. The estimated total cost of the Masa program to the Government of Botswana amounted to approximately 53 million USD in 2010. We project, with certain assumptions, that this figure may reach 117 million USD by 2015. The costs estimated are those borne by the government over this time period, as opposed to the total value of all HIV/AIDS care and services nationally in Botswana. In other words, we have calculated costs to the government of care and treatment only, not including donations by foundations and other private or public sources, as well as instrumental support and aid, such as that provided by the US Government’s PEPFAR program. Without these donations and other sources of support, the government of Botswana would be responsible for costs above and beyond those estimated in this model.
Discussion: Conclusion: This costing exercise highlights that the three primary drivers of the provision of ART in the Masa program are ARV drugs, laboratory tests, and human resources. Further investment in scale-up of the Masa program will be urgently needed to achieve full coverage of eligible patients over the next five years.
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