{
  "abstract": "Background: Differentiated service delivery (DSD) models have been introduced to optimise HIV care by tailoring services to patient needs, but evidence on their cost-effectiveness in Ethiopia is limited.\n\nObjective: To evaluate the cost-effectiveness of DSD models for HIV care compared with standard of care (SOC) in North Wollo, Ethiopia.\n\nStudy design: Retrospective economic evaluation using bottom-up microcosting from a healthcare provider perspective.\n\nSetting: One hospital and three health centres in North Wollo Zone, Ethiopia, from January 2024 to December 2024.\n\nParticipants: 786 adults (≥18 years) on antiretroviral therapy, including 393 receiving DSD (across nine models: 6-month multimonth dispensing, 3-month multimonth dispensing, appointment spacing, community antiretroviral therapy (ART) groups (CAG), FastTrack, maternal and child health, peer-led, adolescent groups and key population models) and 393 receiving SOC.\n\nMain outcome measures: Total annual cost per patient (USD), retention in care at 12 months (%) and incremental cost-effectiveness ratios (ICERs) expressed as cost per additional patient retained.\n\nStatistical analysis: Costs were annualised at a 3% discount rate. ICERs were calculated comparing each DSD model to SOC. Deterministic one-way sensitivity analysis (±20% for medication cost and retention rate) assessed robustness.\n\nResults: SOC had the highest annual cost per patient (US$295) and lowest retention (76.6%). All DSD models were dominant (lower cost, higher retention) with negative ICERs. CAG was the most cost-effective (US$199 per patient; 93.0% retention; ICER –5.85), followed by FastTrack (US$212; 92.9%; –5.09) and adolescent groups (US$238; 90.5%; –4.10). Sensitivity analyses confirmed robustness; no scenario reversed dominance.\n\nConclusion: DSD models, particularly CAG, FastTrack and adolescent groups, provide more cost-effective HIV care than SOC in Ethiopia by achieving higher retention at lower costs. Scaling up these models could optimise resource allocation and reduce health system burden.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Pharmacy, Woldia University, Woldia, Ethiopia",
    "Department of Pharmacy, Debre Berhan University, Debre Birhan, Ethiopia"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Tenaw Baye Tarekegn",
      "orcid": "0000-0001-9348-1488"
    },
    {
      "affs": [
        1
      ],
      "name": "Teshome Bitew Demelash"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/cwrhytn8en14m.bib",
  "cited_by": 0,
  "doi": "10.1136/bmjopen-2026-120948",
  "fulltext_url": null,
  "id": "cwrhytn8en14m",
  "issns": [
    "2044-6055",
    "2044-6055"
  ],
  "landing_url": "https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-120948",
  "language": null,
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2725|HIV/AIDS Research and Interventions"
    ]
  ],
  "openalex": "W7220406901",
  "pdf_url": "https://bmjopen.bmj.com/content/bmjopen/16/10/e120948.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-05",
  "publisher": "BMJ",
  "ris": "https://research.draconitic.com/paper/cwrhytn8en14m.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:44Z",
      "native_id": "10.1136/bmjopen-2026-120948",
      "source": "crossref",
      "url": "https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-120948"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2725|HIV/AIDS Research and Interventions",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Cost-effectiveness of differentiated HIV service delivery in North Wollo, Ethiopia: a retrospective study",
  "title_text": "Cost-effectiveness of differentiated HIV service delivery in North Wollo, Ethiopia: a retrospective study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:44Z",
  "url": "https://research.draconitic.com/paper/cwrhytn8en14m",
  "venue": "BMJ Open",
  "versions": []
}