Integration of HIV and NCD Service Provision: Cost Savings and Implications in Nakuru County, Kenya

Abstract

Dwindling donor funding has been on the rise. Therefore healthcare systems are forced to strategize on how to manage their service delivery with the available resources. There is need to sustain the healthcare services delivery. Integration of Human Immunodeficiency Virus (HIV) and (Non-Communicable Diseases) NCDs services has emerged as a potential solution to improve patient outcomes and optimize resource utilization. This study aimed to evaluate the cost savings associated with integrating HIV services with three common NCDs: Diabetes Mellitus (DM), hypertension (HTN), and the combination of diabetes and hypertension (DM/HTN) in Nakuru County. Methods: This study utilized a hybrid costing approach that combined both top-down and ingredients approaches. The costing analysis took a health system perspective and for acute conditions, the time horizon considered was a case management episode. To determine cost savings, integrated service costs were subtracted from the cumulative costs of individual services on a per-case basis. Results: Integration of HIV and diabetes services resulted in annual cost savings of KES 7,086 (21%) per case. Similarly, integrating HIV with hypertension services yielded cost savings of KES 6,166 (19%) per case. The greatest cost savings were observed when integrating HIV with both diabetes and hypertension services, with annual savings of KES 10,653 (29%) per case. Conclusion: The study results prove that integrating HIV/NCD services would save the healthcare system costs incurred while delivering the services in a parallel model. Hence recommends that healthcare service delivery be supported using an integrated care model to enhance sustainability of the services that have been heavily funded by donors in this country.