TY  - JOUR
SN  - 2633-4402
PB  - National Institute for Health and Care Research
UR  - https://doi.org/10.3310/nihropenres.13794.2
ID  - discovery10205915
N2  - Background:
The number of people living with multiple chronic conditions in sub-Saharan Africa is increasing, but health facilities are unable to meet demand. To improve health system capacity and access to care, community models of HIV care have been trialled in countries such as Tanzania and Uganda. However, no evidence exists to inform policymakers on the effectiveness and cost-effectiveness of integrated community-based models of care for HIV and chronic non-communicable conditions. This protocol outlines a within-trial economic evaluation to address this gap.
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Methods & analysis:
We will estimate the costs and cost-effectiveness of integrated community-based care for HIV, hypertension and diabetes compared with facility-based care within the INTE-COMM pragmatic cluster-randomised trial in Tanzania and Uganda. Analyses will adopt a 52-week time horizon, the duration of trial follow-up. The full enrolled trial sample will be analysed from a societal perspective, comprising provider and patient perspectives. Economic costs will be estimated, which includes valuing inputs such as donated goods or time foregone by participants because of receiving care. For provider costs, participant case report forms will inform resource use along with data from facilities and community sites. Resources will be valued using project accounts, facility spending, and locally available cost data. Patient costs will be estimated based on a care-seeking and cost questionnaire administered to participants. Estimated costs will be analysed with co-primary trial outcomes on plasma viral load suppression, glycaemia and blood pressure control to calculate incremental cost-effectiveness ratios (ICER). We will also calculate ICERs for secondary trial outcomes related to health-related quality of life and wellbeing. Cost drivers and outcomes will be varied within confidence bounds in a two-way sensitivity analysis. We will investigate equity impact by estimating the mean difference in outcomes between integrated community-based and facility-based care across household socio-economic quintiles and by measuring whether participants incurred catastrophic health expenditures.
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Trial registration number:
The ISRCTN Registry: ISRCTN15319595. Registered on 07 June 2022: https://doi.org/10.1186/ISRCTN15319595
KW  - Economic evaluation
KW  -  HIV
KW  -  diabetes
KW  -  hypertension
KW  -  non-communicable diseases
KW  -  integrated care
KW  -  community care
KW  -  sub-Saharan Africa
A1  - Abou Jaoude, Gerard Joseph
A1  - Namakoola, Ivan
A1  - Aikaeli, Faith
A1  - Kimaro, Godfather
A1  - Moyo, Faith
A1  - Kasujja, Francis Xavier
A1  - Van Widenfelt, Erik
A1  - Kivuyo, Sokoine
A1  - Birungi, Josephine
A1  - Mutungi, Gerald
A1  - Ubuguyu, Omary Said
A1  - Watiti, Stephen
A1  - Ramaiya, Kaushik
A1  - Mfinanga, Sayoki
A1  - Nyirenda, Moffat
A1  - Garrib, Anupam
A1  - Jaffar, Shabbar
A1  - Skordis, Jolene
A1  - Batura, Neha
JF  - NIHR Open Research
AV  - public
VL  - 4
Y1  - 2025///
TI  - Protocol for the economic evaluation of integrated community-based care compared with integrated facility-based care for HIV, hypertension and diabetes in Tanzania and Uganda (INTE-COMM trial)
[version 2; peer review: 3 approved]
N1  - Copyright © 2025 Abou Jaoude GJ et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, https://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ER  -