Ensuring continuity of care for people living with HIV in five European countries: The efficiency of the EmERGE platform

Background: Calculate the efficiency of the EmERGE Pathway of Care for medically stable people living with HIV managed at five European HIV clinics (Table 1) The Pathway allows for EmERGE participants to communicate virtually with their caregivers Methods: EmERGE participants, followed up between 2016 and 2019, mainly used HIV outpatient services Micro-costing studies were performed at each site Unit and annual costs were calculated in national currencies and converted to US$ 2018 OECD purchasing parity prices (PPPs) Costs were linked to mean per patient year (MPPY) use of outpatient services Data on use of services were collected retrospectively one year before and prospectively one year after the introduction of EmERGE Annual costs of HIV outpatient services were combined with primary outcome measures (CD4 count, viral load) to assess efficiency Out-of-pocket expenditure data were also collected Results: Two thousand, two hundred and fifty-one participants recruited: 87% to 93% men, mean age at recruitment 41 to 47 years;70% to 84% had full-time employment, median 37 5 hours/week and monthly income $1580;5% to 16% participants received social services support, median $318 to 1558/month Median sick days three months before enrolment was zero days (IQR 0 to 1);50% to 82% participants did not take days off to visit clinic and the return trip took a median 1 5 to 2 0 hours at a median cost $5 to 41 MPPY outpatient visits decreased in four sites from 9% to 31% and associated costs from 5% to 33% (Table 1);use and costs increased by 8% in one site Cost of ARVs comprised 83% to 91% annual outpatient costs Annual costs of use of HIV services was similar across four clinics, but one site, located in one of the least affluent countries, had higher ARV costs Primary outcome measures of participants did not change substantially during the study Conclusions: Implementation of the EmERGE Pathway was efficient in all sites ARVs were the main cost drivers;a country's national socio-economic situation should be considered when setting ARV prices Other structural changes also affect costs, as demonstrated in two clinics, where changes resulted in reductions and increases of annual costs respectively Future efficiencies can be anticipated by the introduction of the Pathway for all people living with HIV or those with other chronic diseases as has been demonstrated during the Covid-19 pandemic