Financial implications of scaling up antiretroviral programs in Uganda and Senegal

Uganda's HIV prevalence is currently estimated at about 6% while that of Senegal is at about 1.5%. Currently, an estimated 1.2 million and 83,000 are living with HIV/AIDS in Uganda and Senegal respectively (UNAIDS 2004). Approximately 33,000 and 2,300 HIV+ patients were on antiretroviral drugs as per estimates of December 2004. Both countries have started scaling up antiretroviral therapy programs hence the need for the current study. The annual and lifetime incremental costs of antiretroviral therapy programs were analyzed using the Cape Town Antiretroviral Costing Model developed by Boulle et al, (2004). 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 respectively. From the study results it has been concluded that the per patient lifetime costs of antiretroviral therapy are influenced by the costs of Antiretroviral drugs, Laboratory tests and service utilization while the total program costs depend on the number of people started on antiretroviral therapy.