HIV Care Retention and Cost Analysis in Multi‐Month ART Dispensing: A Randomized Controlled Trial in China

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INTRODUCTION: Multi-month dispensing (MMD), as a differentiated service delivery model, can reduce the frequency of clinic visits, waiting time and travel costs for clinically stable people living with HIV. This study aimed to evaluate the impact of 6-month MMD of antiretroviral therapy (ART) on retention and conduct a cost analysis in China. METHODS: We conducted a randomized, non-blind, non-inferiority study from December 2022 to March 2023 at The First Hospital of China Medical University. Eligible participants were randomly assigned to a 3-month dispensing group (n = 789) or a 6-month dispensing group (n = 799) and followed up for 18 months. The proportion of patients continuing ART after 18 months, virological suppression rate (<50 copies/mL) and average treatment cost per patient were evaluated. Cox regression analysis was used to compare treatment retention rates and virological suppression rates between groups, while descriptive statistical analysis was applied to assess cost differences. Cost metrics comprised the average cost per clinic visit and the price of ART medications, among other factors. This trial is registered with ChiCTR2200066438. RESULTS: = 0.0421, p = 0.8375). In terms of cost, the 6-month dispensing group had two fewer annual outpatient visits (3 vs. 5), with total treatment costs reduced by 27.7% (¥931.82 vs. ¥1288.85) and work value loss decreased by 16.7% (¥174.20 vs. ¥209.04 yearly). CONCLUSIONS: Six-month MMD of ART did not reduce treatment retention; instead, it decreased patients' clinic visit costs, thereby meeting cost-effectiveness criteria. CLINICAL TRIAL NUMBER: ChiCTR2200066438.

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