Mobile phone adherence support for antiretroviral therapy: What would it cost the National AIDS Control Program in India? Rodrigues R, Shet A, Swaroop N, Shastri S, Bogg L, De Costa A St. John’s National Academy of Health Sciences, National AIDS Control Organisation Bangalore, India Karolinska Institutet, Stockholm, Sweden WEAE0303

2/17 HIV prevalence : 0.3%* People with HIV: 2.5 million HIV patients on treatment: 0.4million # Study Setting INDIA *UNAIDS. Global Report 2010, # NACO March 2012 Bangalore Private teaching hospital with Government ART center Mysore Government teaching hospital and ART center

3/17 Introduction  Good adherence defers failure to 1 st line ART optimizes healthcare outcomes - reduces healthcare costs *  Interventions involving mobile telephones – found suitable for improving adherence – could reduce healthcare costs *World Health Organisation (2003) Adherence to Long-term Therapies # Weltel Prompting medication reminders- Cameroon

4/17 Objective To assess the cost of weekly mobile phone reminders* for adherence support in the context of the Indian National AIDS control Program * HIVIND trial

5/17 The Mobile Phone Intervention Patient with mobile phone On Ry + Interactive Voice Response Call (IVR) Pictorial SMS Weekly

6/17 Assumptions This costing was from the program perspective: Hence,  Expenses in relation to the trial implementation were not considered  The technical providers of the intervention - considered most economical

7/17 Costing Methodology The sequential procedure for costing was used: 1. Identifying the resource used in natural units (minutes/any other units) 2. Measuring resource use 3. Pricing the resource Sensitivity analysis for intervention scale up: 1. Varying the number of patients (IVR+SMS) 2. Varying the components of intervention ie; (i) SMS alone (ii) IVR alone and

8/17 Costs  One time costs: Costs incurred for Intervention development  Recurrent Costs:  Fixed costs: Annual maintenance fee for equipment, staff cost, overheads  Variable cost: IVR and SMS cost/ patient, staff cost- intervention related  Total Costs:  One time cost + Fixed costs + n (variable costs)

9/17 Results One-time costs Costs (USD) Annualised cost (USD) Development of the intervention452.99/5yrs90.60 Development of the web interface201.33/5yrs40.27 Equipment costs [1 computer (10% time) and 1 mobile phone)664.38/5yrs13.29 Total one time costs One time costs

10/17 Fixed costs Cost (USD) Annualised cost (USD) Service maintenance603.99/year Equipment maintenance28.19/3years9.40 Program manager (10% of annual time, USD/mth salary) Overheads201.33/year Data manager (15min/week, USD/mth salary)10.63 Total fixed cost Fixed Cost

11/17 Variable Costs Costs (USD) Annual Cost/patient (USD) IVR cost0.030/IVR1.57 SMS cost0.004/SMS0.21 Counselor (20min/patient/year, 24.16USD/mth salary)0.11 Total variable cost 1.89 Total costs Annual Cost (USD) One-time cost + Fixed costs + n (variable costs) Total Cost/patient (number of patients 1600) 2.82 Variable and Total costs/ patient

12/17 Sensitivity analysis: Total and variable costs intervention scale up

13/17 Sensitivity analysis: Cost for intervention scale-up (IVR+SMS) Costs USD One time cost Fixed cost Variable cost/patient Total cost Total cost/patient Patients Total cost of Intervention scale-up for 0.8 million patients: 0.16% of the 5year NACP VI budget

14/17 Sensitivity analysis: Cost for IVR / SMS Scale-up RegionKarnatakaIndia Languages532 ART centers44313 Patients InterventionIVRSMSIVRSMSIVRSMS Onetime+ fixed cost (USD) Variable cost/pt Total cost (USD)* Total cost/pt (USD) *Total cost = One time + fixed cost + n (variable cost)

15/17 Conclusion  The Indian National AIDS Control Program would incur an overall cost of 0.16% of its current 5year budget for mobile phone adherence support of ART  Given the current implementation costs, the intervention has the potential to improve health system effectiveness and enable the achievement of program goals in the Indian context

16/17 The authors declare that they have no competing interests

17/17 Thank you!!!