John K R, Rajagopalan Nirmala, Madhuri K V
Community Medicine, Christian Medical College, Vellore, India.
MedGenMed. 2006 Nov 1;8(4):24. doi: 10.1186/1758-2652-8-4-24.
Highly active antiretroviral treatment (HAART) usage in India is escalating. With the government of India launching the free HAART rollout as part of the "3 by 5" initiative, many people living with HIV/AIDS (PLHA) have been able to gain access to HAART medications. Currently, the national HAART centers are located in a few district hospitals (in the high- and medium-prevalence states) and have very stringent criteria for enrolling PLHA. Patients who do not fit these criteria or patients who are too ill to undergo the prolonged wait at the government hospitals avail themselves of nongovernment organization (NGO) services in order to take HAART medications. In addition, the government program has not yet started providing second-line HAART (protease inhibitors). Hence, even with the free HAART rollout, NGOs with the expertise to provide HAART continue to look for funding opportunities and other innovative ways of making HAART available to PLHA. Currently, no study from Indian NGOs has compared the direct and indirect costs of solely managing opportunistic infections (OIs) vs HAART.
Compare direct medical costs (DMC) and nonmedical costs (NMC) with 2005 values accrued by the NGO and PLHA, respectively, for either HAART or exclusive OI management.
Retrospective case study comparison.
Low-cost community care and support center--Freedom Foundation (NGO, Bangalore, south India).
Retrospective analysis data on PLHA accessing treatment at Freedom Foundation between January 1, 2003 and January 1, 2005. The HAART arm included case records of PLHA who initiated HAART at the center, had frequent follow-up, and were between 18 and 55 years of age. The OI arm included records of PLHA who were also frequently followed up, who were in the same age range, who had CD4+ cell counts < 200/microliter (mcL) or an AIDS-defining illness, and who were not on HAART (solely for socioeconomic reasons). A total of 50 records were analyzed. Expenditures on medication, hospitalization, diagnostics, and NMC (such as food and travel for a caregiver) were calculated for each group.
At 2005 costs, the median DMC plus NMC in the OI group was 21,335 Indian rupees (Rs) (mean Rs 24,277/-) per patient per year (pppy) (US $474). In the HAART group, the median DMC plus NMC was Rs 18,976/- (mean Rs 21,416/-) pppy (US $421). Median DMC plus NMC pppy in the OI arm was Rs 13623.7/- paid by NGO and Rs 1155/- paid by PLHA. Median DMC and NMC pppy in the HAART arm were Rs 1425/- paid by NGO and Rs 17,606/- paid by PLHA.
Good health at no increased expenditure justifies providing PLHA with HAART even in NGO settings.
印度高效抗逆转录病毒治疗（HAART）的使用正在增加。随着印度政府启动免费HAART推广项目，作为“三五计划”的一部分，许多艾滋病毒/艾滋病感染者（PLHA）得以获取HAART药物。目前，国家级HAART中心设在少数几家地区医院（分布于高流行率和中等流行率的邦），对PLHA的收治标准非常严格。不符合这些标准或病情过重无法在政府医院长时间等待的患者，会选择非政府组织（NGO）的服务来获取HAART药物。此外，政府项目尚未开始提供二线HAART（蛋白酶抑制剂）。因此，即便有免费HAART推广项目，具备提供HAART专业能力的非政府组织仍在继续寻求资金机会及其他创新方式，以便让PLHA能够获取HAART。目前，尚无印度非政府组织开展的研究对单纯管理机会性感染（OI）与HAART的直接和间接成本进行比较。
比较非政府组织和PLHA分别因HAART或单纯的机会性感染管理在2005年产生的直接医疗成本（DMC）和非医疗成本（NMC）。
回顾性病例对照研究。
低成本社区护理与支持中心——自由基金会（位于印度南部班加罗尔的非政府组织）。
对2003年1月1日至2005年1月1日期间在自由基金会接受治疗的PLHA的回顾性分析数据。HAART组包括在该中心开始接受HAART治疗、接受频繁随访且年龄在18至55岁之间的PLHA的病例记录。机会性感染组包括同样接受频繁随访、年龄范围相同、CD4 + 细胞计数<200/微升（mcL）或患有艾滋病界定疾病且未接受HAART治疗（仅出于社会经济原因）的PLHA的记录。共分析了50份记录。计算了每组在药物、住院、诊断以及非医疗成本（如护理人员的食物和交通费用）方面的支出。
按2005年成本计算，机会性感染组每位患者每年的DMC加NMC中位数为21335印度卢比（Rs）（平均24277卢比/人年）（474美元）。HAART组中DMC加NMC中位数为18976卢比/人年（平均21416卢比/人年）（421美元）。机会性感染组中每位患者每年的DMC加NMC中位数中，非政府组织支付13623.7卢比，PLHA支付1155卢比。HAART组中每位患者每年的DMC和NMC中位数中，非政府组织支付1425卢比，PLHA支付17606卢比。
即使在非政府组织环境下，以不增加支出的方式保持良好健康状况，也说明应为PLHA提供HAART。
