Patient costs incurred by people living with HIV/AIDS prior to ART initiation in primary healthcare facilities in Gauteng, South Africa.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
24
03
2017
accepted:
29
12
2018
entrez:
12
2
2019
pubmed:
12
2
2019
medline:
31
10
2019
Statut:
epublish
Résumé
To quantify costs to patients of accessing HIV care prior to ART initiation. Using a cross-sectional study design, costs incurred by HIV-positive patients prior to ART initiation were estimated at urban primary healthcare facilities in South Africa. Costs included direct costs, indirect (productivity) costs, carer and coping costs (value of assets sold and money borrowed). The percentage of individual income spent on healthcare was calculated and compared by patient income tertiles and CD4 count strata. 289 patients (69% female, mean age 37 (SD: 10) years, median CD4 317 (IQR: 138-494) cells/mm3) were interviewed. The total mean monthly cost of pre-ART care was US$15.71. Indirect costs accounted for $2.59 (16.49%) of this when time was valued using the patient's reported income. The mean monthly patient costs were $31.61, $12.78, $12.65 and $11.93 for those with a CD4 count <100, 101-350, 351-500 and >500 cells/mm3 respectively. The percentage of individual income spent on healthcare was 7.25% for those with a CD4 count <100 cells/mm3 and 4.05% for those with a CD4 count >500 cells/mm3. Despite the provision of charge-free services at public clinics, care prior to ART initiation can be costly, particularly for the poor and unemployed. Our study adds to the growing body of evidence that highlights the need to consider policies to reduce the economic barriers to HIV service access, particularly for low income or unwell patient groups, such as improving access to disability grants.
Identifiants
pubmed: 30742623
doi: 10.1371/journal.pone.0210622
pii: PONE-D-17-11548
pmc: PMC6370193
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0210622Subventions
Organisme : Medical Research Council
ID : MR/K012126/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/R010161/1
Pays : United Kingdom
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
AIDS Patient Care STDS. 2015 May;29(5):299-306
pubmed: 25692575
AIDS. 2008 Jul;22 Suppl 1:S131-9
pubmed: 18664945
Soc Sci Med. 2015 Apr;130:42-50
pubmed: 25681713
Health Econ Policy Law. 2012 Jul;7(3):309-26
pubmed: 21310095
J Acquir Immune Defic Syndr. 2015 Oct 1;70(2):e52-60
pubmed: 26371611
BMC Public Health. 2008 Jan 11;8:11
pubmed: 18186946
Afr J Tradit Complement Altern Med. 2011;8(4):337-45
pubmed: 22654209
Int J Tuberc Lung Dis. 2013 Mar;17(3):381-7
pubmed: 23407227
Health Aff (Millwood). 2012 Jul;31(7):1459-69
pubmed: 22778335
Trop Med Int Health. 2010 Jan;15(1):18-25
pubmed: 19891758
AIDS. 2010 Nov 13;24(17):2717-25
pubmed: 20935554
BMC Public Health. 2008 Feb 18;8:63
pubmed: 18282286
Scand J Public Health Suppl. 2007 Aug;69:181-5
pubmed: 17676521
Int J Tuberc Lung Dis. 2003 Sep;7(9 Suppl 1):S56-62
pubmed: 12971655
Health Policy Plan. 1996 Sep;11(3):219-37
pubmed: 10160370
S Afr Med J. 2007 Jul;97(7):524-9
pubmed: 17805455
Southeast Asian J Trop Med Public Health. 2012 Nov;43(6):1521-36
pubmed: 23413717
PLoS One. 2017 Aug 3;12(8):e0181519
pubmed: 28771504
Trop Med Int Health. 2010 Jun;15 Suppl 1:48-54
pubmed: 20586960
PLoS Med. 2006 Jan;3(1):e4
pubmed: 16318413
Int J Tuberc Lung Dis. 2008 Aug;12(8):928-35
pubmed: 18647453
BMC Public Health. 2009 Aug 05;9:283
pubmed: 19656370
AIDS Care. 2007 May;19(5):658-65
pubmed: 17505927
BMC Health Serv Res. 2015 Jun 09;15:227
pubmed: 26050715
Int J Tuberc Lung Dis. 2010 May;14(5):604-10
pubmed: 20392354
Lancet Glob Health. 2015 Aug;3(8):e450-e457
pubmed: 26187490
J Int AIDS Soc. 2010 Mar 06;13:8
pubmed: 20205930
PLoS One. 2014 May 07;9(5):e96867
pubmed: 24806474
AIDS Behav. 2011 May;15(4):842-52
pubmed: 20628898
BMC Public Health. 2011 Jan 18;11:43
pubmed: 21244656