Out-of-pocket costs of AIDS care in China: are free antiretroviral drugs enough?

Abstract

Financial access to HIV care and treatment can be difficult for many people in China, where the government provides free antiretroviral drugs but does not cover the cost of other medically necessary components, such as lab tests and drugs for opportunistic infections. This article estimates out-of-pocket costs for treatment and care that a person living with HIV/AIDS in China might face over the course of one year. Data comes from two treatment projects run by Médecins Sans Frontières in Nanning, Guangxi Province and Xiangfan, Hubei Province. Based on the national treatment guidelines, we estimated costs for seven different patient profiles ranging from WHO Clinical Stages I through IV. We found that patients face significant financial barriers to even qualify for the free ARV program. For those who do, HIV care and treatment can be a catastrophic health expenditure, with cumulative patient contributions ranging from approximately US$200-3939/year in Nanning and US$13-1179/year in Xiangfan, depending on the patient's clinical stage of HIV infection. In Nanning, these expenses translate as up to 340% of an urban resident's annual income or 1200% for rural residents; in Xiangfan, expenses rise to 116% of annual income for city dwellers and 295% in rural areas. While providing ARV drugs free of charge is an important step, the costs of other components of care constitute important financial barriers that may exclude patients from accessing appropriate care. Such barriers can also lead to undesirable outcomes in the future, such as impoverishment of AIDS-affected households, higher ARV drug-resistance rates and greater need for complex, expensive second-line antiretroviral drugs.

Consequences of Drug Abuse and HIV/AIDS in China: Recommendations for Integrated Care of HIV-Infected Drug Users

“…59 Médecins Sans Frontières (MSF) carried out an analysis recently on PLWHA's medical cost in China, and discovered that the annual medical cost for those who can get free ARV drugs translated to 116%-340% of an urban resident's annual income and 295%-1200% of the rural resident. 60 In addition, to be eligible for the ''Four Frees and One Care'' policy, individual must get drugs from appointed health care sites according to the hukou (an official residency registration card), thus, excluding many migrant workers.…”

What Is the Economic Burden of Subsidized HIV/AIDS Treatment Services on Patients in Nigeria and Is This Burden Catastrophic to Households?

“…Patients pay for non- ART drugs for opportunistic infections, non- routine tests, medical consultations, transportation, feeding and hospital stays. [3,4] The costs of these often have impoverishing effects on some households and hinder them from getting the necessary care[3] [4], especially in settings like Nigeria where payment for healthcare remains predominantly through out-of-pocket (OOP) payments. [5]…”

Economic Support to Patients in HIV and TB Grants in Rounds 7 and 10 from the Global Fund to Fight AIDS, Tuberculosis and Malaria

“…Financial factors are also cited in studies of follow-up in prevention-of-mother-to-child-transmission programs [36]. Cost for patients of HIV treatment is estimated to correspond to 100% or more of annual income in China, Cote d'Ivoire, Indonesia, South Africa, Tanzania and Thailand [37], [38], [39]. Although there is little published research on economic support and treatment, improved uptake of HIV testing and treatment and improved treatment outcomes have been reported in respect of a number of social protection interventions, such as cash transfers [40], and food support [41].…”