Patient costs associated with accessing HIV/AIDS care in Malawi
Patient costs associated with accessing HIV/AIDS care in Malawi
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DOI：
10.7448/ias.16.1.18055
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发表时间：
2013-03-19
影响因子：
6
通讯作者：
Sodhi, Sumeet K.
中科院分区：
文献类型：
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作者：
Pinto, Andrew D.;van Lettow, Monique;Sodhi, Sumeet K.
导言：艾滋病毒服务的权力下放已被证明可以改善撒哈拉以南非洲农村穷人获得护理的公平性。本研究旨在帮助我们了解权力下放对患者承担的费用的影响。这些信息对于从社会角度对抗逆转录病毒疗法方案进行经济评价很有价值。我们比较了在城市集中式项目中接受护理的患者与在同一地区通过农村分散式护理（DC）接受护理的患者报告的成本。方法：2010年5月进行了一项关于患者特征和获得艾滋病毒护理相关费用的横断面调查，对马拉维Zomba区一家三级转诊医院的120名集中护理（CC）患者和五个农村卫生中心的120名DC患者进行了研究。各组所承担的成本的差异进行了比较，使用卡方（2）和t检验，回归模型的开发，以调整混杂因素，使用bootstrapping来解决歪斜的成本data.Results：有没有组之间的性别和年龄方面的显着差异。然而，在社会经济地位方面存在显著差异，CC中的教育程度（p < 0.001）、个人收入（p = 0.007）和人均家庭收入（p = 0.005）较高。旅行时间相似（p = 0.65），在诊所等待的时间（p = 0.63）和寻求护理的总时间（p = 0.65）也相似。有一个显着的差异，在旅行相关的费用（p < 0.001）有关的类型的旅行参与者指出，他们使用。在CC，60%的参与者报告使用小巴到达诊所;在DC，只有4%的人报告使用小巴，其余的人报告步行或骑自行车。在报告的收入损失或其他自付费用方面，两组之间没有显著差异。大约91马拉维克瓦查（95%的置信区间：1 = 182 MKW）或0.59美元代表CC和DC.Conclusions之间的每次访问的总成本的调整后的差异：即使在艾滋病毒/艾滋病护理系统中，患者不支付看医生或大多数药物，他们仍然会产生费用。我们发现大多数成本与旅行相关。这对居住在远离卫生设施的较贫困患者具有重要影响，因为这些费用可能很高。
Introduction: The decentralization of HIV services has been shown to improve equity in access to care for the rural poor of sub-Saharan Africa. This study aims to contribute to our understanding of the impact of decentralization on costs borne by patients. Such information is valuable for economic evaluations of anti-retroviral therapy programmes that take a societal perspective. We compared costs reported by patients who received care in an urban centralized programme to those in the same district who received care through rural decentralized care (DC).Methods: A cross-sectional survey on patient characteristics and costs associated with accessing HIV care was conducted, in May 2010, on 120 patients in centralized care (CC) at a tertiary referral hospital and 120 patients in DC at five rural health centres in Zomba District, Malawi. Differences in costs borne by each group were compared using chi(2) and t-tests, and a regression model was developed to adjust for confounders, using bootstrapping to address skewed cost data.Results: There was no significant difference between the groups with respect to sex and age. However, there were significant differences in socio-economic status, with higher educational attainment (p < 0.001), personal income (p = 0.007) and household income per person (p = 0.005) in CC. Travel times were similar (p = 0.65), as was time waiting at the clinic (p = 0.63) and total time spent seeking care (p = 0.65). There was a significant difference in travel-related expenses (p < 0.001) related to the type of travel participants noted that they used. In CC, 60% of participants reported using a mini-bus to reach the clinic; in DC only 4% reported using a mini-bus, and the remainder reported travelling on foot or by bicycle. There were no significant differences between the groups in the amount of lost income reported or other out-of-pocket costs. Approximately 91 Malawi Kwacha (95% confidence intervals: 1 = 182 MKW) or US$0.59 represents the adjusted difference in total costs per visit between CC and DC.Conclusions: Even within a system of HIV/AIDS care where patients do not pay to see clinicians or for most medications, they still incur costs. We found that most costs are travel related. This has important implications for poorer patients who live at a distance from health facilities for whom these costs may be significant.