Cost analysis of integrating hypertension and diabetes management into routine HIV care in Mbarara and Ibanda districts, Uganda

Abstract

Background In 2016, Uganda initiated integration of services for non-communicable diseases, including hypertension and diabetes, into existing HIV care services. However, this intervention has not been fully implemented yet in most HIV clinics. We evaluated the costs associated with scaling up hypertension and diabetes management services in selected HIV clinics in Mbarara and Ibanda districts, Uganda. Methods In March 2023, we obtained data on costs of providing hypertension and diabetes services in ten randomly selected HIV clinics in Mbarara and Ibanda districts including, healthcare providers’ salaries, time spent offering to these services, training costs, medications, and patient monitoring systems. Using the HEARTS costing tool, we estimated the annual costs of providing hypertension and diabetes services. We disaggregated annual costs by the domains of the HEARTS costing tool. We determined the average annual cost and medication expenses for hypertension and diabetes treatment per enrolled adult patient stratified by type of health facility. Results The total annual cost of hypertension and diabetes management services in ten selected HIV clinics was estimated to be $413,850 (range: $8,386 − 186,973). The annual average clinic-level cost per enrolled patient was estimated at $14 (range: $7 − 31). Of the total annual cost, the cost of provider time for initial and follow-up visits represented the largest cost component in 5/10 clinics (mean: 37%, range [13–58%]). In 4/10 clinics, the major cost components were the costs of medication, diagnostic tests, and related supplies (mean: 37%, range [10–75%]). The average cost per enrolled adult patient was $11 at public facilities and $21 in private not-for-profit facilities. The average medication cost per patient for hypertension was $24 (range: $7 − 97) annually; $13 at public facilities and $50 at private, not-for-profit facilities. For diabetes treatment, the average annual medication cost per patient was estimated at $14 (range: $6 − 35); $11 at public facilities and $22 at private not-for-profit facilities. Conclusion Integrating hypertension and diabetes management into routine HIV care might be feasible based on the estimated annual cost per patient. Hypertension and diabetes treatment was more costly in private not-for-profit facility-based clinics than at public facilities, primarily driven by the higher costs of medications.