The Financial Burden of Morbidity in HIV-Infected Adults on Antiretroviral Therapy in Côte d'Ivoire

Abstract

BackgroundLarge HIV care programs frequently subsidize antiretroviral (ARV) drugs and CD4 tests, but patients must often pay for other health-related drugs and services. We estimated the financial burden of health care for households with HIV-infected adults taking antiretroviral therapy (ART) in Côte d'Ivoire.Methodology/Principal FindingsWe conducted a cross-sectional survey. After obtaining informed consent, we interviewed HIV-infected adults taking ART who had consecutively attended one of 18 HIV care facilities in Abidjan. We collected information on socioeconomic and medical characteristics. The main economic indicators were household capacity-to-pay (overall expenses minus food expenses), and health care expenditures. The primary outcome was the percentage of households confronted with catastrophic health expenditures (health expenditures were defined as catastrophic if they were greater than or equal to 40% of the capacity-to-pay). We recruited 1,190 adults. Median CD4 count was 187/mm3, median time on ART was 14 months, and 72% of subjects were women. Mean household capacity-to-pay was $213.7/month, mean health expenditures were $24.3/month, and 12.3% of households faced catastrophic health expenditures. Of the health expenditures, 75.3% were for the study subject (ARV drugs and CD4 tests, 24.6%; morbidity events diagnosis and treatment, 50.1%; transportation to HIV care centres, 25.3%) and 24.7% were for other household members. When we stratified by most recent CD4 count, morbidity events related expenses were significantly lower when subjects had higher CD4 counts.Conclusions/SignificanceMany households in Côte d'Ivoire face catastrophic health expenditures that are not attributable to ARV drugs or routine follow-up tests. Innovative schemes should be developed to help HIV-infected patients on ART face the cost of morbidity events.

Health expenditure and catastrophic spending among older adults living with HIV

“…This is confirmed by Tanzania data which found that increased age, female sex, obesity, and disability increased adults' OOP health expenditures significantly -and, among older adults specifically (60+), disability and visiting traditional healers increased expenditures (Brinda et al, 2014). In Cote d'Ivoire, sex, duration of ART use, education of the household head, household size and household income quintile were all significant predictors of CHE (Beauliere et al, 2010). Furthermore, rural households have been found to spend a larger proportion of their annual budgets on health care compared to urban households (7.8% and 5.7% respectively; Chuma & Maina, 2012).…”

“…The cost of health care is not the only barrier to health-care access; there are a wide range of affordability, availability, and acceptability barriers, which affect poorer groups most severely (Macha et al, 2012). Research by Beauliere et al (2010) in Cote d'Ivoire and Rosen et al (2007) in South Africa indicate that in circumstances where ART is provided free to patients, OOP payments and CHE can be incurred due to non-ART-related medical expenses or travel costs (Beauliere et al, 2010;Rosen et al, 2007).…”

“…HIV-positive households also tend to be larger, poorer, and have lower employment rates than those unaffected by HIV (Bachmann & Booysen, 2003). In countries that provide free access to antiretroviral drugs and treatment (ART), considerable OOP expenditure can still be incurred by HIV-positive people through direct costs such as diagnostic tests, treatment of morbidity events after ART initiation, and travel to the health facility as well as indirect costs such as substitute labour or income loss (Beauliere et al, 2010;Chimbindi, Bor, et al, 2014;Rosen, Ketlhapile, Sanne, & Bachman DeSilva, 2007).…”

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]…”

Postpartum Depression and HIV Infection Among Women in Malawi

“…They may also experience stress due to HIV-associated stigma or anticipation of stigma 16 . Additionally, HIV-infected households often face increased levels of socioeconomic stressors due to the cost of healthcare and the impact that a chronic illness can have on the ability of family members to work 17, 18 . Research on the prevalence of perinatal depression in HIV-infected women has been limited, with the majority focused on the prenatal period 12, 13, 19-30 .…”