Patient costs incurred by people living with HIV/AIDS prior to ART initiation in primary healthcare facilities in Gauteng, South Africa

Pillai, Natasha and Foster, Nicola and Hanifa, Yasmeen and Ndlovu, Nontobeko and Fielding, Katherine and Churchyard, Gavin and Chihota, Violet and Grant, Alison D and Vassall, Anna (2019) Patient costs incurred by people living with HIV/AIDS prior to ART initiation in primary healthcare facilities in Gauteng, South Africa. PLoS ONE, 14 (2). ISSN 1932-6203

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Abstract

Purpose To quantify costs to patients of accessing HIV care prior to ART initiation. Materials and methods 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. Results 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. Conclusions 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.

Item Type: Journal Article
Journal or Publication Title: PLoS ONE
Uncontrolled Keywords: /dk/atira/pure/subjectarea/asjc/2700
Subjects:
Departments: Faculty of Health and Medicine > Health Research
ID Code: 137138
Deposited By: ep_importer_pure
Deposited On: 02 Oct 2019 12:45
Refereed?: Yes
Published?: Published
Last Modified: 14 Dec 2019 05:14
URI: https://eprints.lancs.ac.uk/id/eprint/137138

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