THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Annual cost per client for ART treatment in Uganda; Experiences from TASO Uganda 18 th ICASA, 2015, Harare, Zimbabwe Presenter: Karukoma Gordon FCCA-Chief Accountant Authors: Karukoma Gordon, Ssali Livingstone, Stephen Okoboi, Mushabe Elizabeth, Dr. Kisaakye Victoria(PhD), Dr. Etukoit B. Michael, Dr. Sam Kalibala

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Founded in 1987 by 16 individuals personally affected by HIV and AIDS Vision: “A world without HIV and AIDS” Mission: To contribute to the process of preventing HIV, restoring hope & improving the quality of life of PLWHA & their families. Annually 120,000 PLHIV in care

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Background TASO ART program started in 2004; with PEPFAR support ART to > 68,584 patients across the 11 centers serving more than 55 districts in Uganda. TASO uses a decentralised structure with the national office in Kampala.

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Objective of the Cost Analysis To estimate the cost – Per ART visit for each patient and – Annual cost per ART patient; To provide information to guide budgeting, planning and resource mobilisation

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Methods Retrospective document review using a standard cost data capture tool – Financial records for the period January to December 2012 To extract data from e-systems: – the ART drug cost – number of clients – number of visits – operational cost – and other costs related to service delivery

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: 4/11 TASO Centers Selected each with the following characteristics Characteristics EntebbeGuluJinjaRukungiri HIV Prevalence (adults aged 15-49) 7.1%9.0%5.8%8.3% GeographySemi-urbanRuralSemi-urbanRural Doctor33 33 Clinical officers Nurses Lab technician Data Manager Total16 14 # of ART clients6,3296,9695,4544,062 # of ART visits23,46128,65432,23327,693

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Methods….. Direct costs of ARV drugs and other ART-specific commodities were captured and analyzed at face value. Aggregate annual ART and related costs were divided – by the total number of annual visits and – the total number of annual patients To estimate cost per patient visit and annual cost per ART patient respectively.

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Findings: Average cost per visit and annual cost per client (2012) Location Total expenditure (USD) Total ART clients Total ART visits Average annual visits/ client Average cost per ART visit (USD) Annual cost per ART client (USD) TASO Rural - Gulu $2,094,6956,96928,6544.1$73$301 Rural - Rukungiri $1,944,0964,60227,6936.0$70$422 Semi-Urban - Jinja $1,969,9405,45432,2335.9$61$361 Semi-Urban - Entebbe $1,744,2316,32923,4613.7$74$276 AVERAGE COST $7,752,96222,814112,0414.8$69$332

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Findings: Average cost per visit and annual cost per client (2012) Location Total expenditure (USD) Total ART clients Total ART visits Average annual visits/ client Average cost per ART visit (USD) Annual cost per ART client (USD) TASO Rural - Gulu $2,094,6956,96928,6544.1$73$301 Rural - Rukungiri $1,944,0964,60227,6936.0$70$422 Semi-Urban - Jinja $1,969,9405,45432,2335.9$61$361 Semi-Urban - Entebbe $1,744,2316,32923,4613.7$74$276 AVERAGE COST $7,752,96222,814112,0414.8$69$332

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Lessons Learnt The annual unit cost per ART patient was US $ 332 compared to findings from previous studies (2012 PEPFAR estimate of US $ 335) Use of efficient financial management systems are critical in improving program performance Use of community system models is important in retaining patients on treatment This low cost has enhanced the number of patients initiated on treatment

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Recommendation  Quality and robust e-financial management systems.  Synergies between programs and financial health workers.  Periodic program and financial management reviews.  Establishment of quality assurance measures and systems

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Limitations Data for this study were collected retrospectively thus were likely to have been subject to errors among other data quality issues.

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: In Partnership With;