OBJECTIVES

: The HIV prevalence rate in Mali is 1.1% according to the 2012-2013 EDSM. The dynamics of the epidemic are concentrated in the key populations: MSM, SW. ARCAD is a national community-based association and a major player in the fight against AIDS.

The objective of the study is to analyze the economic consequences of the evolution of the community-based HIV care model in Mali.

METHODS

: A 5 year-budgetary impact model was developed to compare the current community care model (scenario 0) with the future community care model (scenario 1). ARCAD point of view was adopted.

Epidemiological data were extracted from SPECTRUM 5 software to calculate the projected prevalent and incident population. Full costs were accounted for with a distinction between fixed and variable costs.

The modalities of community-based care are set to evolve, with the placing under national supervision of in-hospitals, the strengthening of the key population prevention structure, and the extension of the offer to tuberculosis

RESULTS

: The community care offer in scenario 0 includes 16 centers for 50% of the active file of HIV patients (33,909 patients in 2021). The scenario 1 offer includes 7 centers for 30% of the active HIV patient population (20,345 patients in 2021).

In terms of full cost, scenario 0 costs 2,605,425,861 CFA for 2021 and scenario 1 costs 2,183,762,360 CFA. Thus the budgetary impact of the new community-based HIV care offer in Mali is a saving of 421,663,501 CFA for the first year and a saving of 2,137,824,255 CFA over 5 years.

CONCLUSIONS

: The community-based HIV care model in Mali is evolving, particularly with structures that will become public structures but also with the extension of prevention to tuberculosis. This evolution reduces the active file of patients treated in the community setting but increases the components of care while making savings.