TY - JOUR
T1 - The financial burden of morbidity in HIV-infected adults on antiretroviral therapy in Côte d'Ivoire
AU - Beaulière, Arnousse
AU - Touré, Siaka
AU - Alexandre, Pierre Kébreau
AU - Koné, Koko
AU - Pouhé, Alex
AU - Kouadio, Bertin
AU - Journy, Neige
AU - Son, Jérôme
AU - Ettiègne-Traoré, Virginie
AU - Dabis, François
AU - Eholié, Serge
AU - Anglaret, Xavier
N1 - Funding Information:
The World Health Organization (WHO) estimated that 480,000 adults and children were living with HIV in Côte d'Ivoire, West Africa in late 2007. Of the 190,000 persons who were estimated to be in need of antiretroviral therapy (ART), 51,812 (28%) were actually receiving ART . Most of these patients had started ART within the previous three years, primarily thanks to support from the US President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria .
PY - 2010
Y1 - 2010
N2 - Background: Large 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 Cô te d'Ivoire. Methodology/Principal Findings: We 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/Significance: Many households in Cô te 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.
AB - Background: Large 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 Cô te d'Ivoire. Methodology/Principal Findings: We 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/Significance: Many households in Cô te 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.
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U2 - 10.1371/journal.pone.0011213
DO - 10.1371/journal.pone.0011213
M3 - Article
C2 - 20585454
AN - SCOPUS:77955299403
SN - 1932-6203
VL - 5
JO - PLoS One
JF - PLoS One
IS - 6
M1 - e11213
ER -