Abstract
This study aims to 1) to review the policy and process of implementation for provision of antiretroviral therapy, 2) to assess quality and adequacy of hospital services for ARV provision. 3) to assess the effects on health and behavior of people with HIV/AIDS receiving ARV and 4) to study costs and cost-effectiveness for provision of ARV therapy comparing between provincial and district hospitals. The study conducts the documents relevant to national HIV policy was analyzed, and in-depth interview was performed with people responsible for ATC project. The 12 provinces stratified by region were randomly selected: Ayutthaya, Lopburi, Prajinburi, Prajuabkeyrekhun, Surin, Udonthani, Aumnartchareon, Sukothai, Nan, Chiang Mai, Krabi and Songkla. In each province, a provincial hospital was purposively selected and two district hospitals were randomly selected. The total numbers was 36 hospitals. The hospital visits was performed by the research team to assess quality of services for ARV. Practice guidelines, record form, and documents relevant to ATC project were reviewed. Focus group discussions and individual interviews were conducted with hospital personnel including doctors, nurses, counselor and laboratory technician, who provide care for people with HIV/AIDS. The hospital records of people enrolled in the ATC project during the fiscal year 2003 were reviewed. Survivals, incidence of opportunistic infections, clinical failure, changes of CD4 cell count at six months after treatment initiated, were analyzed. People with HIV/AIDS who currently receives ARV treatment were interviewed for their perceptions on health status, adherence, social and behavior impacts of ARV medication. The costs and cost-effectiveness study was conducted in three hospitals in Chiang Mai province. The overall cost of ARV provision was a combination of provider cost at ARV clinic, laboratory cost, ARV drug cost and patients cost. The overall costs/person/year and cost-effectiveness were analyzed. Results found that at present, after seven months of expansion of existing ATC project to reach the target of 50,000 in the year 2004, an average enrollment of new cases was 5 percent per month. The 33,381 people with HIV/AIDS were enrolled and this was about 66.7 percent of the project target. However, a number of people were with some reason dropout from the project and 29,549 people remained in the project during this period of time The cost of ARV drugs was approximately 60-80 percent of overall costs of ARV services. The fundamental ARV formula in the ATC project was GPO-Vir which was cheapest compared to the others.
