Evidence map›Paper›PMID 41191352›Full record

Trial reportJAMA network open2025

Cost-Effectiveness of Linkage Case Management for Hospitalized People With HIV.

Megan Willkens, Benson Issarow, Godfrey Kisigo, Philip Ayieko, Derick Deogratias, Thomas Rutachunzibwa, Severin Kabakama, Daniel Fitzgerald, Heiner Grosskurth, Elialilia Okello and 5 more

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Trial
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Megan WillkensCenter for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York.
Benson IssarowMwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
Godfrey KisigoMwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
Philip AyiekoMwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
Derick DeogratiasMwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
Thomas RutachunzibwaMinistry of Health, Mwanza, Tanzania.
Severin KabakamaMwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
Daniel FitzgeraldCenter for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York.
Heiner GrosskurthMwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
Elialilia OkelloMwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
Lisa R MetschDepartment of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York.
Saidi KapigaMwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
Myung Hee LeeCenter for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York.
Robert N PeckCenter for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York.
Sean M MurphyDepartment of Population Health Sciences, Weill Cornell Medicine, New York, New York.

Funding

Reducing Post-Hospital Mortality in HIV-Infected Adults in TanzaniaR01MH118107 · NIMH · WEILL MEDICAL COLL OF CORNELL UNIV · PI PECK, ROBERT N · 2018 to 2022
$2.7M
Patient-Oriented Research in Global Cardiovascular Diseases and Interactions with HIVK24HL170902 · NHLBI · WEILL MEDICAL COLL OF CORNELL UNIV · PI Robert N Peck · 2023 to 2026
$504k
NHLBI NIH HHS K24 HL170902NIMH NIH HHS R01 MH118107
6 · The paper itself

Abstract

Importance: The Daraja randomized clinical trial was a linkage case management intervention designed to improve HIV care engagement. Understanding the economic value of this type of case management intervention is essential to decision-makers in resource-constrained settings seeking to minimize HIV-related morbidity and mortality. Objective: To evaluate the cost-effectiveness of Daraja compared with enhanced standard care from the Tanzania Ministry of Health and societal perspectives. Design, Setting, and Participants: This prospective economic evaluation was conducted alongside the Daraja randomized clinical trial at 20 hospitals in Northwestern Tanzania from March 2019 to May 2023. Participants were patients hospitalized with HIV randomly assigned 1:1 to receive either the Daraja intervention or enhanced standard care and were followed up for 12 months through March 2023. Data were analyzed from May 2024 to March 2025. Exposure: The Daraja intervention group received up to 5 sessions conducted by a social worker at the hospital, in the home, and in the HIV clinic over a 3-month period. The enhanced standard care group received predischarge HIV counseling and assistance in scheduling an HIV clinic appointment. Main Outcomes and Measures: The primary outcome was the cost per disability-adjusted life-year (DALY) averted for Daraja vs standard care, assessed from Ministry of Health and societal perspectives at 3 months (intervention) and 12 months (intervention plus follow-up). Results: Among 500 participants, the mean (SD) age was 37 [12] years, and 384 participants (77%) were female. Participants in the intervention group incurred more costs from the Tanzanian Ministry of Health perspective over the 3-month intervention period ($43.4 vs $24.0; difference, $19.4 [95% CI, $9.2 to $29.6]) and over the 12-month observation period ($101.6 vs $78.2; difference, $23.4 [95% CI, $8.0 to $38.9]). From the societal perspective, Daraja incurred more costs than standard care at 3 months ($72.4 vs $47.4; difference, $25.0 [95% CI, $2.0 to $48.0]) but not 12 months ($182.7 vs $160.5; difference, $22.2 [95% CI, -$16.4 to 60.8]). DALYs were lower for Daraja participants at both the 3-month (1.2 [95% CI, 1.1 to 1.2] DALYs averted, annualized) and 12-month (1.1 [95% CI, 1.3 to 3.7] DALYs averted) time points. Conclusions and Relevance: In this economic evaluation of the Daraja intervention, Daraja was more costly than standard care from both the Tanzanian Ministry of Health and societal perspectives; however, it was associated with improvements in DALYs. These findings suggest that Daraja has a high probability of being considered cost-effective from both economic perspectives.

Indexed as

Case ManagementCost-Benefit AnalysisHIV InfectionsHospitalizationAdultFemaleHumansMaleMiddle AgedProspective StudiesTanzania

Identifiers

PMID41191352
PMCPMC12590294

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.