| dc.description.abstract | Background- Uganda is one of the countries with a high economic burden of both cervical cancer and HIV/AIDS. These two diseases share the same risk factors and women with HIV/AIDS have two to twelve chances of suffering from cervical cancer. Therefore, to minimise this risk there is a need to integrate cervical cancer screening into HIV care. However, for optimal allocation of resources and effective decision making the Cost-Effectiveness Analysis (CEA) of integrating these two services needs to be established. This is what formed the gist of the investigation. Aim of the Study- To estimate the Cost-Effectiveness Analysis of Integrating cervical cancer screening into HIV care in Uganda. Method- Patient data was collected using Retrospective Review Chart. Using this method, 20,000 patient folders were reviewed and 16,366 folders met the study criteria of which 2,065 HIV positive women had received cervical cancer screening from 2012 to 2016. Only costs incurred from the provider perspective were included in the study. The differences in costs of screening the entire population and the costs incurred under voluntary screening (status quo) were divided by the differences in total life-years gained from screening the entire population and life-years gained under status quo. The effect of uncertainty on model parameters was examined by conducting a probabilistic sensitivity analysis. Results- The patient characteristics in the study that were associated with cervical cancer included: age of HIV positive women screened, status of Antiretroviral therapy and the CD4 count. These were assessed at the bivariate and multivariate stages. At both stages, it was revealed that age and CD4 count were statistically significant to the cervical cancer screening among HIV positive women. However, the status of antiretrBackground- Uganda is one of the countries with a high economic burden of both cervical cancer and HIV/AIDS. These two diseases share the same risk factors and women with HIV/AIDS have two to twelve chances of suffering from cervical cancer. Therefore, to minimise this risk there is a need to integrate cervical cancer screening into HIV care. However, for optimal allocation of resources and effective decision making the Cost-Effectiveness Analysis (CEA) of integrating these two services needs to be established. This is what formed the gist of the investigation. Aim of the Study- To estimate the Cost-Effectiveness Analysis of Integrating cervical cancer screening into HIV care in Uganda. Method- Patient data was collected using Retrospective Review Chart. Using this method, 20,000 patient folders were reviewed and 16,366 folders met the study criteria of which 2,065 HIV positive women had received cervical cancer screening from 2012 to 2016. Only costs incurred from the provider perspective were included in the study. The differences in costs of screening the entire population and the costs incurred under voluntary screening (status quo) were divided by the differences in total life-years gained from screening the entire population and life-years gained under status quo. The effect of uncertainty on model parameters was examined by conducting a probabilistic sensitivity analysis. Results- The patient characteristics in the study that were associated with cervical cancer included: age of HIV positive women screened, status of Antiretroviral therapy and the CD4 count. These were assessed at the bivariate and multivariate stages. At both stages, it was revealed that age and CD4 count were statistically significant to the cervical cancer screening among HIV positive women. However, the status of antiretroviral therapy was not statistically significant to cervical cancer screening outcome. The cost-per-positive-screening result among HIV positive women was 50 USD. The Incremental Cost-Effectiveness Ratio of 46.5 per life-year gained from cervical cancer screening was estimated. However, the study used a 5-year survival probability estimate of cervical cancer from a Tanzanian study to conclude that the integration of cervical cancer into HIV care in Uganda was cost-effective. This is because the survival probability estimates of cervical cancer in Uganda have not yet been estimated. Conclusion- The integration of cervical cancer screening into HIV care is highly cost-effective and it has the potential to prevent High-Grade precancerous lesions from progressing into cervical cancer among HIV-positive women. oviral therapy was not statistically significant to cervical cancer screening outcome. The cost-per-positive-screening result among HIV-positive women was 50 USD. The Incremental Cost-Effectiveness Ratio of 46.5 per life-year gained from cervical cancer screening was estimated. However, the study used a 5-year survival probability estimate of cervical cancer from a Tanzanian study to conclude that the integration of cervical cancer into HIV care in Uganda was cost-effective. This is because the survival probability estimates of cervical cancer in Uganda have not yet been estimated. Conclusion- The integration of cervical cancer screening into HIV care is highly cost-effective and it has the potential to prevent High-Grade precancerous lesions from progressing into cervical cancer among HIV-positive women. | nob |