OBJECTIVES: Assess the direct and indirect costs from the patient’s perspective of decentralizing HIV care and treatment for men who have sex with men (MSM) in Guatemala City.

METHODS: This was the first pilot study conducted to partially decentralize HIV care and treatment for MSM living with HIV in Guatemala City from January, 2017 to May, 2018. Participants eligible for decentralization were offered the opportunity to voluntarily choose one of three decentralized clinics, while those who were not received care at a reference hospital. Direct and indirect costs were determined from the patient's perspective. The economic impact of decentralization was evaluated by comparing direct and indirect costs between decentralized and non-decentralized patients measured through baseline and endline surveys. Direct costs were measured from expenditures on transportation to the clinic, lodging, food, and health and sanitary services. Indirect costs were measured from time spent traveling and receiving care. Longitudinal qualitative interviews were conducted with a sub-sample of patients (n=30) to elicit their experiences with care over time.

RESULTS: Of 262 eligible participants, 47% choose to be decentralized. Average age and income were similar between decentralized and non-decentralized patients, 36 years (SD = ±9.5) and $USD 408 (IQR: 265-679). Overall, decentralized patients reported lower indirect costs during the study period (p-value<0.000). Per visit, the total mean direct costs were $USD 6 (CI95%: 4-7) and $USD 8 (CI95%: 6-10); indirect costs were $USD 10 (CI95%: 8-11) and $USD 18 (CI95%: 16-21); and total economic costs were $USD 15 (CI95%: 12-18) and $USD 27 (CI95%: 23-32), for decentralized and non-decentralized, respectively. In qualitative interviews, decentralized patients reported favorably on their experience due to reduced time and high quality of care.

CONCLUSIONS: Decentralization reduced lost productivity, maintained retention in care, and was a favorable experience among patients.