Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

Uganda's HIV prevalence is estimated at 6% and Senegal at 1.5%. An estimated 1.2 million and 83,000 people are living with HIV/AIDS in Uganda and Senegal respectively. Approximately 33,000 and 2,300 HIV+ patients were on antiretroviral estimates as of December 2004. Methods: The annual and lifetime incremental costs of antiretroviral therapy (ART) programs were analyzed using the Cape Town Antiretroviral Costing Model developed by Boulle et al, (2004). The financials sustainability issues were discussed through oral interviews with key informants in both countries. Results: Annual average per patient costs increased from US$ 541 in 2004 to US$ 687 by the end of 2008 for Uganda, and US$ 622 to US$ 912 for Senegal. Antiretroviral drugs accounted for the largest proportion of the average per patient costs, accounting for 68% in Uganda and 81% in Senegal. Second line regimens were found to be more expensive than first line regimens thus leading to increasing average per patient antiretroviral therapy costs with the years as the proportion of patients on second line increased from 9% in 2004 to 22% by the end of 2008. The program total costs by the end of 2008 for starting 18,500 patients in Senegal and 82,000 patients in Uganda were estimated at US$ 20.5 million and US$ 68 million. Funds for ART services were estimated at US$ 79 million (Senegal) and US$ 74 million (Uganda). Senegal is contributing 65% of its ART program costs and Uganda has not allocated funds from its domestic budget for its program. Conclusions: Patient lifetime costs of ART are influenced by the costs of antiretroviral drugs and Laboratory tests. Total program costs depend on the number of people started on ART. ART services in Uganda might not be financially sustainable without donor funding whereas Senegal may be able to finance its ART program.