Richter Linda M, Lönnroth Knut, Desmond Chris, Jackson Robin, Jaramillo Ernesto, Weil Diana
HIV, AIDS, STIs and TB, Human Sciences Research Council, Durban, KwaZulu-Natal, South Africa ; Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
HIV/AIDS, TB, Malaria and Neglected Tropical Diseases (HTM), World Health Organization, Geneva, Switzerland.
PLoS One. 2014 Jan 28;9(1):e86225. doi: 10.1371/journal.pone.0086225. eCollection 2014.
People with TB and/or HIV frequently experience severe economic barriers to health care, including out-of-pocket expenses related to diagnosis and treatment, as well as indirect costs due to loss of income. These barriers can both aggravate economic hardship and prevent or delay diagnosis, treatment and successful outcome, leading to increased transmission, morbidity and mortality. WHO, UNAIDS and the ILO argue that economic support of various kinds is essential to enable vulnerable people to protect themselves from infection, avoid delayed diagnosis and treatment, overcome barriers to adherence, and avert destitution. This paper analyses successful country proposals to the Global Fund to Fight AIDS, Tuberculosis and Malaria that include economic support in Rounds 7 and 10; 36 and 20 HIV and TB grants in Round 7 and 32 and 26, respectively, in Round 10. Of these, up to 84 percent included direct or indirect economic support for beneficiaries, although the amount constituted a very small proportion of the total grant. In TB grants, the objectives of economic support were generally clearly stated, and focused on mechanisms to improve treatment uptake and adherence, and the case was most clearly made for MDR-TB patients. In HIV grants, the objectives were much broader in scope, including mitigation of adverse economic and social effects of HIV and its treatment on both patients and families. The analysis shows that economic support is on the radar for countries developing Global Fund proposals, and a wide range of economic support activities are in place. In order to move forward in this area, the wealth of country experience that exists needs to be collated, assessed and disseminated. In addition to trials, operational research and programme evaluations, more precise guidance to countries is needed to inform evidence-based decision about activities that are cost-effective, affordable and feasible.
结核病患者和/或艾滋病毒感染者在获得医疗保健方面经常面临严重的经济障碍，包括与诊断和治疗相关的自付费用，以及因收入损失造成的间接成本。这些障碍既会加剧经济困难，又会妨碍或延误诊断、治疗及取得成功的治疗效果，从而导致传播、发病率和死亡率上升。世卫组织、联合国艾滋病规划署和国际劳工组织认为，提供各种经济支持对于使弱势群体能够保护自己免受感染、避免诊断和治疗延误、克服坚持治疗的障碍以及避免贫困至关重要。本文分析了向全球抗击艾滋病、结核病和疟疾基金提交的成功国家提案，这些提案在第7轮和第10轮中包括经济支持；第7轮有36项艾滋病毒和结核病赠款，第10轮分别有32项和26项。其中，高达84%的提案包括对受益人的直接或间接经济支持，尽管这笔金额在总赠款中所占比例非常小。在结核病赠款中，经济支持的目标通常表述明确，重点是提高治疗利用率和坚持治疗的机制，耐多药结核病患者的情况最为明显。在艾滋病毒赠款中，目标范围要广泛得多，包括减轻艾滋病毒及其治疗对患者和家庭造成的不利经济和社会影响。分析表明，经济支持已被列入制定全球基金提案的国家的考虑范围，并且已经开展了广泛的经济支持活动。为了在这一领域取得进展，需要整理、评估和传播现有的丰富国家经验。除了试验、业务研究和项目评估之外，还需要为各国提供更精确的指导，以便就具有成本效益、可负担且可行的活动做出基于证据的决策。
