Cost and cost-effectiveness of home-based care for HIV/AIDS in the urban setting-a case of Nairobi, Kenya
Oyugi, Nick Aguluu
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In global, regional and local AIDS responses, inadequate resources was continually an overriding challenge; and as such, it was crucial that HIV services were cost-effective and that maximum outputs were derived from resources utilized (UNAIDS 2005). Broad objective of the study was to determine costs and cost-effectiveness of the alternative approaches of home-based care for HIV I AIDS in Nairobi. The study was descriptive cross-sectional survey with aspects of home-based care being elucidated for purposes of establishing programme costs, and was conducted in Nairobi. Five home-based care providers were purposively selected from 13 eligible ones that had been identified earlier by snowballing. The study's data gathering was by face-to-face interview of programme managers or their representatives using an interview schedule. Further data collection was undertaken using observation and document reviews. The study's data analysis was summarizing of raw data into programme input and output data and data on costs, and then presenting and interpreting. These data analysis procedures were aided by Microsoft Excel for doing graphs and SPSS for doing Pearson's correlation analysis. Total monthly programme cost of providing home-based care for HIV I AIDS in Nairobi ranged from US $ 5,706 per month to US $ 44,138 per month; with the cost being higher for approaches of NGO-based and church-based. Major cost components in home-based care of Nairobi were: drugs and medical supplies, staff salary and food assistance-these three cost components constituted between 69% and 93% of total cost. Church-based was the most cost-effective home-based care approach in Nairobi-its unit costs were US $ 16.30 per patient per month and US $ 1.30 per home visit. In the home-based care programmes of Nairobi, total monthly costs of operating home care programmes increased with number of patients cared for and total home visits per month=-correlation between monthly total costs and number of patients cared for was statistically significant (r = 0.117, P = 0.026). Also statistically significant was the correlation between monthly total costs and total home visits per month (r = 0.171, P = 0.003). On the contrary, cost per patient per month decreased with number of patients cared for or total home visits per month=-correlations between cost per patient per month and number of patients cared for, or total home visits per month, were statistically significant (r = -0.110, P = 0.044 and r = -0.141, P = 0.014 respectively). Likewise, monthly cost per home visit decreased with number of patients cared for or total home visits per month=-correlations between monthly cost per home visit and number of patients cared for, or total home visits per month, were statistically significant (r = -0.167, P = 0.002 and r = -0.228, P = 0.001 respectively). The study recommended that in order to strengthen home-based care for HIV I AIDS service in urban settings, the existing partnerships between the government and NGO or faith based home-based care providers should persist as pre-existing vulnerabilities had prevented communities of urban informal settlements from mounting effective responses on their own. Also that, increasing staff size, but more importantly increasing volunteer numbers, was critical in any effort to expand home-based care for HIV/AIDS by government, or their stakeholders. For in home-based care, human resources determined programme outputs and were cost drivers.