HIV treatment support services in Tanzania: a cost and efficiency analysis at facility and community levels.

Differentiated service delivery models provide an opportunity to reduce the cost of HIV treatment while increasing the focus on advanced patients. Also, stable patients who need less attention can visit facilities less frequently, saving time and money and reducing overcrowding. Tanzania needs treatment support services that can improve the quality of life, ensure adherence and result in viral suppression. Treatment support services can be provided through a variety of models, including at the community level, through the facility or through some combination of the two. Understanding the cost of each model is essential for policy-makers who must allocate resources. Data from neighbouring countries suggests that community-level support services can be beneficial to patients, especially in reducing loss to follow-up and death. Though community-based HIV services are available in Tanzania, uncertainty about the costs of these models remain. This study assessed the costs of treatment support services at 27 sites in Tanzania. The cost analysis found that the average unit cost of treatment support services is US$39 per patient per year. The analysis found that community-based models have clear advantages with regard to the number of patients that can be reached with support services. Costing data indicated that community-based models are also less expensive. The lack of data on retention limited any conclusions about whether community-based models are the most effective within the Tanzanian context.