1. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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

2. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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

3. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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.

4. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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

5. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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

6. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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 officers2 2 1 1 Nurses5 5 5 5 Lab technician3 3 2 2 Data Manager3 3 3 3 Total16 14 # of ART clients6,3296,9695,4544,062 # of ART visits23,46128,65432,23327,693

7. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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.

8. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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

9. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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

10. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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

11. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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

12. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Limitations Data for this study were collected retrospectively thus were likely to have been subject to errors among other data quality issues.

13. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org In Partnership With;