OBJECTIVES

The HIV prevalence rate in Mali is 1.1% according to the 2012-2013 EDSM. ARCAD is a national community-based association and a major player in the fight against AIDS. ARCAD's community-based intervention strategies have been implemented in 19 care sites throughout the country: 13 in-hospitals, 2 community centers, 4 “key” populations prevention structures. The objective of the study is to analyze the cost-effectiveness of the different ARCAD management strategies.

METHODS

A decision tree was developed on the proportion of patients tested positive for HIV and followed up in a facility with an undetectable viral load at 12 months. The perspective adopted is the civil society in Mali. Five structures were compared: the community center in Bamako, the community center in Mopti, the in-hospitals in Bamako, the other in-hospitals and the key population prevention structure in Bamako. The transition probabilities of interest were calculated from the monthly management report of each facility. The valuation of the costs of the facilities was done at full cost by taking the direct and indirect costs from the ARCAD accounts.

RESULTS

The key population prevention structure in Bamako is the least expensive at 63,137 CFA. The most effective strategy is the community center in Bamako with 25.5% of patients screened, followed up and having an undetectable CV at 12 months. The community center in Bamako is more expensive by 28,759 CFA but also more efficient by 1 point than the key population prevention structure in Bamako, which represents a 5% increase in efficiency. The incremental cost-effectiveness ratio between the two strategies is 2,363,970 CFA / additional efficiency point.

CONCLUSIONS

The efficiency of HIV care management strategies in Mali depends on various criteria. The open nature of the community center in Bamako and their openness to key populations, such as in Bamako, allow for greater efficiency in care.