Poudel Ak Narayan, Newlands David, Simkhada Padam
International Public Health Researcher, Public Health Institute, Faculty of Education, Health and Community, Liverpool John Moores University, England, UK.
Institute for Global Health and Development, Queen Margret University, Edinburgh, UK.
BMC Health Serv Res. 2017 Jan 24;17(1):76. doi: 10.1186/s12913-017-1976-y.
There have been only limited studies assessing the economic burden of HIV/AIDS in terms of direct costs, and there has been no published study related to productivity costs in Nepal. Therefore, this study explores in detail the economic burden of HIV/AIDS, including direct costs and productivity costs. This paper focuses on the direct costs of seeking treatment, productivity costs, and related factors affecting direct costs, and productivity costs.
This study was a cross-sectional, quantitative study. The primary data were collected through a structured face-to-face survey from 415 people living with HIV/AIDS (PLHIV). The study was conducted in six representative treatment centres of six districts of Nepal. The data analysis regarding the economic burden (direct costs and productivity costs) was performed from the household's perspective. Descriptive statistics have been used, and regression analyses were applied to examine the extent, nature and determinants of the burden of the disease, and its correlations.
Average total costs due to HIV/AIDS (the sum of average total direct and average productivity costs before adjustment for coping strategies) were Nepalese Rupees (NRs) 2233 per month (US$ 30.2/month), which was 28.5% of the sample households' average monthly income. The average total direct costs for seeking HIV/AIDS treatment were NRs 1512 (US$ 20.4), and average productivity costs (before adjustment for coping strategies) were NRs 721 (US$ 9.7). The average monthly productivity losses (before adjustment for coping strategies) were 5.05 days per person. The major determinants for the direct costs were household income, occupation, health status of respondents, respondents accompanied or not, and study district. Health status of respondents, ethnicity, sexual orientation and study district were important determinants for productivity costs.
The study concluded that HIV/AIDS has caused a significant economic burden for PLHIV and their families in Nepal. The study has a number of policy implications for different stakeholders. Provision of social support and income generating programmes to HIV-affected individuals and their families, and decentralising treatment services in each district seem to be viable solutions to reduce the economic burden of HIV-affected individuals and households.
仅有有限的研究从直接成本方面评估了艾滋病毒/艾滋病的经济负担，且在尼泊尔尚无关于生产力成本的已发表研究。因此，本研究详细探讨了艾滋病毒/艾滋病的经济负担，包括直接成本和生产力成本。本文聚焦于寻求治疗的直接成本、生产力成本以及影响直接成本和生产力成本的相关因素。
本研究为横断面定量研究。通过对415名艾滋病毒/艾滋病感染者（PLHIV）进行结构化面对面调查收集原始数据。研究在尼泊尔六个地区的六个代表性治疗中心开展。从家庭角度对经济负担（直接成本和生产力成本）进行数据分析。使用了描述性统计方法，并应用回归分析来检验疾病负担的程度、性质和决定因素及其相关性。
艾滋病毒/艾滋病导致的平均总成本（在未针对应对策略进行调整的情况下，平均总直接成本与平均生产力成本之和）为每月2233尼泊尔卢比（30.2美元/月），占样本家庭平均月收入的28.5%。寻求艾滋病毒/艾滋病治疗的平均总直接成本为1512尼泊尔卢比（20.4美元），平均生产力成本（在未针对应对策略进行调整的情况下）为721尼泊尔卢比（9.7美元）。每人每月的平均生产力损失（在未针对应对策略进行调整的情况下）为5.05天。直接成本的主要决定因素包括家庭收入、职业、受访者的健康状况、是否有陪同人员以及研究地区。受访者的健康状况、种族、性取向和研究地区是生产力成本的重要决定因素。
该研究得出结论，艾滋病毒/艾滋病给尼泊尔的艾滋病毒/艾滋病感染者及其家庭造成了重大经济负担。该研究对不同利益相关者具有若干政策启示。为受艾滋病毒影响的个人及其家庭提供社会支持和创收项目，以及在每个地区分散治疗服务，似乎是减轻受艾滋病毒影响的个人和家庭经济负担的可行解决方案。
