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AIDS Research and Treatment
Volume 2014, Article ID 235483, 5 pages
Research Article

Resource Utilization and Costs of Care prior to ART Initiation for Pediatric Patients in Zambia

1Zambia Center for Applied Health Research and Development, 10100 Lusaka, Zambia
2Center for Global Health and Development, Boston University, Boston, MA 02118, USA
3Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Clinical Medicine, School of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
4Zambian Ministry of Health, 10100 Lusaka, Zambia
5Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
6Centre for Infectious Disease Research in Zambia, 101000 Lusaka, Zambia
7Department of International Health, School of Public Health, Boston University, Boston, MA 02118, USA

Received 14 December 2013; Accepted 6 February 2014; Published 10 March 2014

Academic Editor: Robert R. Redfield

Copyright © 2014 Hari S. Iyer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. We estimated time to initiation, outpatient resource use, and costs of outpatient care during the 6 months prior to ART initiation for HIV-infected pediatric patients in Zambia. Methods. We enrolled 1,102 children who initiated ART at <15 years of age between 2006 and 2011 at 5 study sites. Of these, 832 initiated ART ≤6 months after first presenting to care at the study sites. Data on time in care and resources utilized during the 6 months prior to ART initiation were extracted from patient medical records. Costs were estimated from the provider’s perspective and are reported in 2011 USD. Results. For the patients who initiated ART ≤6 months after presenting to care, median age at presentation to care was 3.9 years; median CD4 percentage was 13%. Median time to ART initiation was 26 days. Patients made, on average, 2.38 clinic visits prior to ART initiation and received 0.81 CD4 tests, 0.74 full blood count tests, and 0.49 blood chemistry tests. The mean cost of pre-ART care was $20 per patient. Conclusions. Zambian pediatric patients initiating ART ≤6 months after presenting to care do so quickly, utilize fewer resources than mandated by national guidelines, and accrue low costs.