Research guides convenient and cost-effective long-term HIV care in Namibia

Healthcare providers at the Katutura Health Centre in Windhoek receive point-of-care viral load testing training during August 2020. Photo supplied by the Ministry of Health and Social services.

Credit: CDC Namibia

January is often a time when people review their budgets, both personally and professionally. For government bodies, the financial year is drawing to a close, and the operation of the last couple of months of the fiscal year are impacted by the pressures and stressors of the year, and how well the budget has been managed in response to these stressors. The year 2020 placed heavy, unexpected financial burdens on many people, and particularly on the healthcare system. While it is critical for general healthcare services to continue, it is more important than ever to ensure that these services are as efficient and cost-effective as possible.

In order to better understand how to support patients and how to best use resources, the Ministry of Health with support from the U.S. Centers for Disease Control and Prevention conducted two research studies. These studies were released at the end of last year. The first study assessed how well Community Adherence Groups (CAGS) support patients, the second assessed the cost of treating stable and unstable patients.

CAGs are groups of 6-12 HIV-positive patients who have their virus under control. The group meet on a regular basis in their community. One of the members will visit their local clinic to all the medicine for the group. The members collect their medicine when they meet as a group. This saves the patients time and money.  The study interviewed patients and healthcare providers from three regions about community adherence groups.

It found that for many patients, being part of a CAG makes it quicker and easier for patients to receive their medication. It also provides members with a safe place and a sense of community. Healthcare workers find community adherence groups as an effective way to support patients, as when stable patients receive their main care through a CAG, healthcare providers can focus on sicker patients who recently found out that they are HIV positive.

‘“As a leader of the group, I look for topics that I think are interesting for the CAG members. Especially because I used to walk around in the community, I used to see the bad things that are happening in the community. That is what I bring up topics like discrimination…They [CAG members] suggest some talks about how to do backyard gardens. With gardens, you can produce your own food like spinach and cabbages,” explained one CAG member from the Oshana region.

The second study compared the cost of care for patients who have the level of the virus under control in their body (stable patients) with the cost of care for patients who do not have the level of the virus under control (unstable patients). The study also compared the cost of care for adults compared to teenagers and children living with HIV. The cost of care was based on the average cost of care over one year.

The results show that the cost of care for a stable HIV positive patient is 2-3 times lower than the cost of care for an HIV-positive patient who is not yet virally suppressed. The highest costs are for laboratory services, healthcare providers and medicine.  The study assessed the cost of patient care at nine clinics over a period of one year.

“We know that the sooner people living with HIV get on treatment, the healthier they will be. The results of this study show that getting patients to regularly take their medicine also has an important impact on the cost of care, particularly by reducing the number of laboratory tests that are required,” said Dr Ndapewa Hamunime, Study Co-investigator and Senior HIV Advisor for the Ministry of Health and Social Services.

Dr Graham Mutandi, Care and Treatment Team Lead from U.S. Centers for Disease Control and Prevention Namibia, further explains, “If we help patients control the virus in their body as soon as possible, we can do less laboratory tests, reduce hospital visits and save a lot of money. Namibia has 204,000 people on treatment. Reducing the cost of HIV care, and still improving the quality of patient, means that the money saved can be spent on other needs within the healthcare system.”

The Ministry of Health has made a number of recommendations from the findings of these studies. For example, the Ministry recommends that the CAG model is expanded into areas beyond HIV alone, such as livelihood, mental health, and other chronic disease care. In order to help HIV-positive patients become stable as quickly as possible, the Ministry will continue to prioritise the roll-out of the new HIV medication, TLD, which is the most effective treatment for the majority of HIV positive patients. The Ministry will also adopt low-cost laboratory technologies as they become available.

“The lessons learned from this study are vital in informing our future resource planning,” concludes Dr Shangula, Ministry of Health and Social Services.

As we move into 2021, the financial pressures brought by COVID-19 will not go away any time soon. In order to strengthen our resilience to meet these challenges, it is critical that we maximise efficiencies where possible, promoting cost-effective service provision and ensuring that patient care is effective. The HIV program is making great strides in this direction and will continue to do so in 2021.