Can telemedicine initiative be an effective intervention strategy for improving treatment compliance for pediatric HIV patients: Evidences on costs and improvement in treatment compliance from Maharashtra, India


Autoři: Sarit Kumar Rout aff001;  Yashwant R. Gabhale aff002;  Ambarish Dutta aff001;  Sudha Balakrishnan aff003;  Mamatha M. Lala aff002;  Maninder Singh Setia aff004;  Khanindra Bhuyan aff005;  Mamta V. Manglani aff002
Působiště autorů: Indian Institute of Public Health, Bhubaneswar, Odisha, India aff001;  Pediatric Centre of Excellence for HIV Care, Department of Pediatrics, LTM Medical College and General Hospital, Sion, Mumbai, India aff002;  UNICEF India, New Delhi, India aff003;  Karanam Consultancy, Mumbai, India aff004;  UNICEF state office, Maharashtra, India aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223303

Souhrn

Background

India has recently introduced telemedicine initiatives to enhance access to specialized care at a low cost for the pediatric HIV patients, who face multiple challenges due to growing disease burden and limited preparedness of the health system to address it. There are limited evidences on the cost-effectiveness of these interventions. This study was undertaken in Maharashtra, a province, located in the western region of the country, to inform policy regarding the effectiveness of this programme. The objective was to estimate the unit cost of ART services for pediatric HIV patients and examine the efficiency in the use of resource and treatment compliance resulting from telemedicine initiatives in pediatric HIV compared to usual ART services.

Methods

We selected 6 ART centers (3 from linked centers linked to Pediatric HIV Centre of Excellence (PCoE) and 3 from non-linked centers) randomly from three high, middle and low ART centers, categorized on the basis of case load in each arm. A bottom up costing methodology was adopted to understand the unit cost of services. Loss to follow up and timeliness of the visits were compared between the two arms and were linked to the cost.

Results

The average cost per-visit was INR 1803 in the linked centers and that for the non-linked centers was INR 3412. There has been 5 percentage point improvement in lost to follow-up in the linked centers compared to non-linked centers against a back-drop of a reduction in per-pediatric patient cost of INR 557. The linkage has resulted in increase in timeliness of the visits in linked centers compared to non-linked centers.

Discussion and conclusion

The telemedicine linkage led to an increase in the case load leading to a decrease in cost. The evidence on efficiency in the use of resource and improvement in treatment compliance as suggested by this study could be used to scale up this initiative.

Klíčová slova:

Cost-effectiveness analysis – HIV – HIV epidemiology – HIV infections – India – Pediatric infections – Pediatrics – Telemedicine


Zdroje

1. Pandve HT, Giri PA. HIV/AIDS prevention and control in india: Achievements and future challenges. N Am J Med Sci. 2015;7: 575–576. doi: 10.4103/1947-2714.172853 26942136

2. Unaids. UNAIDS DATA 2018 [Internet]. 2018. http://www.unaids.org/sites/default/files/media_asset/unaids-data-2018_en.pdf

3. Lala MM, Merchant RH. After 3 decades of paediatric HIV/AIDS—Where do we stand? Indian J Med Res. 2014;140: 704–706. 25758566

4. WHO. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. World Health Organisation. 2013.

5. WHO. A Health Telematics Policy [Internet]. A Health Telematics Policy. 1998. http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:A+health+telematics+policy#5

6. Wootton R. Telemedicine in the National Health Service [Internet]. JOURNAL OF THE ROYAL SOCIETY OF MEDICINE. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1296978/pdf/jrsocmed00018-0008.pdf

7. Burns F. Information for health : an information strategy for the modern NHS 1998–2005 : executive summary. a1104. 1998; 12 p. http://www.imt4nhs.exec.nhs.uk/strategy/index.htm%0Ahttp://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4002944&chk=kwk+Jz

8. Perednia DA. Telemedicine technology and clinical applications. JAMA J Am Med Assoc. 2003;273: 483–488.

9. Whitten PS, Mair FS, Haycox A, May CR, Williams TL, Hellmich S. Systematic review of cost effectiveness studies of telemedicine interventions. doi: 10.1136/bmj.324.7351.1434 12065269

10. Mills A. Health Care Systems in Low- and Middle-Income Countries. N Engl J Med. 2014;370: 552–557. doi: 10.1056/NEJMra1110897 24499213

11. Young JD, Patel M, Badowski M, Mackesy-Amiti ME, Vaughn P, Shicker L, et al. Improved Virologic Suppression With HIV Subspecialty Care in a Large Prison System Using Telemedicine: An Observational Study With Historical Controls. Clin Infect Dis. 2014;59: 123–129. doi: 10.1093/cid/ciu222 24723283

12. Saifu HN, Asch SM, Goetz MB, Smith JP, Graber CJ, Schaberg D, et al. Evaluation of human immunodeficiency virus and hepatitis C telemedicine clinics. Am J Manag Care. 2012;18: 207–12. Available: http://www.ncbi.nlm.nih.gov/pubmed/22554009 22554009

13. Waldura JF, Neff S, Dehlendorf C, Goldschmidt RH. Teleconsultation improves primary care clinicians’ confidence about caring for HIV. J Gen Intern Med. 2013;28: 793–800.

14. Zolfo M, Bateganya MH, Adetifa IM, Colebunders R, Lynen L. Telemedicine service for HIV / AIDS physicians working in developing countries. J Telemed Telecare. 2015; 65–70.

15. Le Doare K, Mackie NE, Kaye S, Bamford A, Walters S, Foster C. Virtual support for paediatric HIV treatment decision making. Arch Dis Child. 2015;100: 527–531. doi: 10.1136/archdischild-2014-307019 25549664

16. Acharya Rajesh V., Rai Jasuma J. Evaluation of patient and doctor perception toward the use of telemedicine in Apollo Tele Health Services, India. J Fam Med Prim Care. 2017; doi: 10.4103/2249-4863.201174 28348994

17. Freedberg KA, Kumarasamy N, Losina E, Cecelia AJ, Scott CA, Divi N, et al. Clinical impact and cost-effectiveness of antiretroviral therapy in India: starting criteria and second-line therapy [Internet]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2365748/pdf/nihms45505.pdf

18. Lallit D, Prem KSG, Anil KG, Rakhi D. Cost-effectiveness of HIV prevention interventions in Andhra Pradesh state of India. BMC Health Serv Res. 2010;10: 117. doi: 10.1186/1472-6963-10-117 20459755

19. Guinness L, Kumaranayake L, Rajaraman B, Sankaranarayanan G, Vannela G, Raghupathi P, et al. Does scale matter? The costs of HIV-prevention interventions for commercial sex workers in India. Bull World Health Organ. 2005;83: 747–755. 16283051

20. Ghia CJ, Patil AS, Ved JK, Jha RK. Benefits of Telemedicine and Barriers to its Effective Implementation in Rural India : A Multicentric E- Survey. Ind Med Gaz. 2013; 1–7.

21. Hogan DR, Baltussen R, Hayashi C, Lauer JA, Salomon JA. Cost effectiveness analysis of strategies to combat HIV/AIDS in developing countries. BMJ. 2005;331: 1431–1437. doi: 10.1136/bmj.38643.368692.68 16282380

22. Dandona L, Kumar SP, Ramesh Y, Rao MC, Kumar AA, Marseille E, et al. Changing cost of HIV interventions in the context of scaling-up in India. Aids. 2009;22: S43–S49. doi: 10.1097/01.aids.0000327622.24232.aa 18664952

23. Walker D. Cost and cost-effectiveness of HIV/AIDS prevention strategies in developing countries: is there an evidence base? Health Policy Plan. 2003;18: 4–17. doi: 10.1093/heapol/18.1.4 12582104

24. PFI. Cost Analysis For Scaling Up Initiatives [Internet]. Population Foundation of India. https://www.populationfoundation.in/Publications/view/21/21

25. Marshall DA, Hux M. Design and Analysis Issues for Economic Analysis Alongside Clinical Trials. Med Care. 2009;47: S14–S20. doi: 10.1097/MLR.0b013e3181a31971 19536012

26. Shepard DS. Cost-effectiveness in Health and Medicine. By Gold M.R. , Siegel J.E , Russell L.B. , and Weinstein M.C. (eds). New York: Oxford University Press, 1996. J Ment Health Policy Econ. 1999;2: 91–92.

27. Marseille E, Kahn JG. Avahan and the cost-effectiveness of “prevention as prevention”. Lancet Glob Heal. 2014;2: e493–e494. doi: 10.1016/s2214-109x(14)70295-5

28. Bhat R. Costing of HIV / AIDS Intervention. 2006.

29. Haacker M, Claeson M. HIV and AIDS in South Asia : an economic development risk (Inglés) [Internet]. 2009. http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2009/02/27/000334955_20090227085524/Rendered/PDF/476080PUB0HIV0101Official0Use0Only1.pdf


Článek vyšel v časopise

PLOS One


2019 Číslo 10

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

Léčba bolesti v ordinaci praktického lékaře
nový kurz
Autoři: MUDr. PhDr. Zdeňka Nováková, Ph.D.

Revmatoidní artritida: včas a k cíli
Autoři: MUDr. Heřman Mann

Jistoty a nástrahy antikoagulační léčby aneb kardiolog - neurolog - farmakolog - nefrolog - právník diskutují
Autoři: doc. MUDr. Štěpán Havránek, Ph.D., prof. MUDr. Roman Herzig, Ph.D., doc. MUDr. Karel Urbánek, Ph.D., prim. MUDr. Jan Vachek, MUDr. et Mgr. Jolana Těšínová, Ph.D.

Léčba akutní pooperační bolesti
Autoři: doc. MUDr. Jiří Málek, CSc.

Nové antipsychotikum kariprazin v léčbě schizofrenie
Autoři: prof. MUDr. Cyril Höschl, DrSc., FRCPsych.

Všechny kurzy
Kurzy Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se