What Is the Economic Burden of Subsidized HIV/AIDS Treatment Services on Patients in Nigeria and Is This Burden Catastrophic to Households?
What Is the Economic Burden of Subsidized HIV/AIDS Treatment Services on Patients in Nigeria and Is This Burden Catastrophic to Households?
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DOI：
10.1371/journal.pone.0167117
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Chiegil R
中科院分区：
文献类型：
--
作者：
Etiaba E;Onwujekwe O;Torpey K;Uzochukwu B;Chiegil R
在尼日利亚，有关补贴抗逆转录病毒治疗项目给家庭带来的经济负担的知识存在差距。这是因为患者还需要支付非抗逆转录病毒治疗药物费用，这可能会限制补贴服务的提供和利用。在尼日利亚的三个州（阿达马瓦州、阿夸伊博姆州和阿南布拉州）对到卫生机构接受艾滋病毒/艾滋病治疗的成年人（18岁以上）进行了一项退出调查。在各州，抗逆转录病毒治疗得到全额补贴，但对其他治疗费用有不同的支付方式。收集和分析了艾滋病毒/艾滋病治疗的直接和间接费用以及门诊和住院期间的合并症的数据。按受访者的州、社会经济地位和城乡位置对灾难性卫生支出水平进行了计算和分类。本研究中的灾难性健康支出（CHE）衡量的是每月与art相关的家庭支出（住院和门诊就诊）占每月非食品支出的比例分别大于40%和10%的受访者人数。平均门诊及住院直接费用分别为5.49元及122.10元。运输费用是最高的非医疗费用，高于大多数医疗费用。合并症的存在增加了家庭成本。在这三个州，所有的成本对于10%和40%门槛的家庭来说都是灾难性的，程度不同。最贫穷的SES五分位数在门诊费用方面的CHE发生率最高（p<0.0001）。与城市居民相比，农村居民在所有类别的费用中都产生了更多的CHE，但只有门诊费用的成本具有统计学意义。抗逆转录病毒治疗补贴不足以消除艾滋病毒患者治疗的经济负担。应当实行分散服务以减少差旅费用，并对艾滋病毒治疗服务的其他组成部分提供补贴，以消除抗逆转录病毒治疗服务持续存在的不公平和高成本负担。应考虑将抗逆转录病毒治疗服务全面纳入国家健康保险计划的一揽子福利。
A gap in knowledge exists regarding the economic burden on households of subsidized anti-retroviral treatment (ART) programs in Nigeria. This is because patients also incur non-ART drug costs, which may constrain the delivery and utilisation of subsidized services. An exit survey of adults (18+years) attending health facilities for HIV/AIDS treatment was conducted in three states in Nigeria (Adamawa, Akwa Ibom and Anambra). In the states, ART was fully subsidized but there were different payment modalities for other costs of treatment. Data was collected and analysed for direct and indirect costs of treatment of HIV/AIDS and co-morbidities’ during out-and in-patient visits. The levels of catastrophic health expenditure (CHE) were computed and disaggregated by state, socio-economic status (SES) and urban-rural location of the respondents. Catastrophic Health Expenditure (CHE) in this study measures the number of respondents whose monthly ART-related household expenditure (for in-patient and out-patient visits) as a proportion of monthly non-food expenditure was greater than 40% and 10% respectively. The average out-patient and in-patient direct costs were $5.49 and $122.10 respectively. Transportation cost was the highest non-medical cost and it was higher than most medical costs. The presence of co-morbidities contributed to household costs. All the costs were catastrophic to households at 10% and 40% thresholds in the three states, to varying degrees. The poorest SES quintile had the highest incidence of CHE for out-patient costs (p<0.0001). Rural dwellers incurred more CHE for all categories of costs compared to urban dwellers, but the costs were statistically significant for only outpatient costs. ART subsidization is not enough to eliminate economic burden of treatment on HIV patients. Service decentralization to reduce travel costs, and subsidy on other components of HIV treatment services should be introduced to eliminate the persisting inequitable and high cost burden of ART services. Full inclusion of ART services within the benefit package of the National Health Insurance Scheme should be considered.
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