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



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.


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.


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 epidemiology – HIV infections – India – Pediatric infections – Pediatrics – Telemedicine


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