Delivery of antiretroviral treatment services in India: estimated costs incurred under the National AIDS Control Programme

ABSTRACT

Competing domestic health priorities and shrinking financial support from external agencies necessitatesthat India’s National AIDS Control Programme (NACP) brings in cost efficiencies to sustain theprogramme. In addition, current plans to expand the criteria for eligibility for antiretroviral therapy(ART) in India will have significant financial implications in the near future. ART centres in India providecomprehensive services to people living with HIV (PLHIV) those fulfilling national eligibility criteriaand receiving ART and those on pre-ART care, i.e. not on ART. ART centres are financially supported(i) directly by the NACP; and (ii) indirectly by general health systems. This study was conducted todetermine (i) the cost incurred per patient per year of pre-ART and ART services at ART centres; and(ii) the proportion of this cost incurred by the NACP and by general health systems. The study usednational data from April 2013 to March 2014, on ART costs and non-ART costs (human resources,laboratory tests, training, prophylaxis and management of opportunistic infections, hospitalization,operational, and programme management). Data were extracted from procurement records andreports, statements of expenditure at national and state level, records and reports from ART centres,databases of the National AIDS Control Organisation, and reports on use of antiretroviral drugs. Theanalysis estimates the cost for ART services as US$ 133.89 (`8032) per patient per year, of which 66%(US$ 88.66, `5320) is for antiretroviral drugs and 34% (US$ 45.23, `2712) is for non-ART recurrentexpenditure, while the cost for pre-ART care is US$ 33.05 (`1983) per patient per year. The low costsincurred for patients in ART and pre-ART care services can be attributed mainly to the low costs ofgeneric drugs. However, further integration with general health systems may facilitate additional costsaving, such as in human resources.