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Engaging Private Providers in HIV Care and Treatment: Lessons from the BroadReach Down Referral Model in North West Province, South Africa

This brief presents an overview of the design, implementation, and initial impact of a private general practitioner down referral model for routine ART services in a heavily HIV-affected region of South Africa. This model was implemented in 2005 to increase access to ART in the short- to medium-term in the Matlosana sub-district of North West Province. Outcomes of the private general practitioner down referral model in Matlosana indicate strong potential for private sector engagement mechanisms such as down referral and contracting out. While the private general practitioner model incurred higher total and average costs than a public-to-public down referral model, examination of the marginal benefit of each patient retained in down referral with successful viral suppression indicates that the private model realizes greater cost efficiency.