Nguyen Quyen Le Thi, Nguyen Long Hoang, Tran Bach Xuan, Phan Huong Thi Thu, Le Huong Thi, Nguyen Hinh Duc, Tran Tho Dinh, Do Cuong Duy, Nguyen Cuong Manh, Thuc Vu Thi Minh, Latkin Carl, Zhang Melvyn W B, Ho Roger C M
Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
PLoS One. 2017 Feb 15;12(2):e0172050. doi: 10.1371/journal.pone.0172050. eCollection 2017.
Viral load testing is considered the gold standard for monitoring HIV treatment; however, given its high cost, some patients cannot afford viral load testing if this testing is not subsidized. Since foreign aid for HIV/AIDS in Vietnam is rapidly decreasing, we sought to assess willingness to pay (WTP) for viral load and CD4 cell count tests among HIV-positive patients, and identified factors that might inform future co-payment schemes.
A multi-site cross-sectional survey was conducted with 1133 HIV-positive patients on antiretroviral therapy (ART) in Hanoi and Nam Dinh. Patients' health insurance coverage, quality of life, and history of illicit drug use were assessed. A contingent valuation approach was employed to measure patients' WTP for CD4 cell count and viral load testing.
HIV-positive patients receiving ART at provincial sites reported more difficulty obtaining health insurance (HI) and had the overall the poorest quality of life. Most patients (90.9%) were willing to pay for CD4 cell count testing; here, the mean WTP was valued at US$8.2 (95%CI = 7.6-8.8 US$) per test. Most patients (87.3%) were also willing to pay for viral load testing; here, mean WTP was valued at US$18.6 (95%CI = 16.3-20.9 US$) per test. High income, high education level, and hospitalization were positively associated with WTP, while co-morbidity with psychiatric symptoms and trouble paying for health insurance were both negatively related to WTP.
These findings raise concerns that HIV-positive patients in Vietnam might have low WTP for CD4 cell count and viral load testing. This means that without foreign financial subsidies, many of these patients would likely go without these important tests. Treating psychiatric co-morbidities, promoting healthcare services utilization, and removing barriers to accessing health insurance may increase WTP for monitoring of HIV/AIDS treatment among HIV+-positive Vietnamese patients.
病毒载量检测被视为监测艾滋病治疗的金标准；然而，鉴于其成本高昂，如果检测没有补贴，一些患者负担不起病毒载量检测费用。由于越南获得的艾滋病防治外援正在迅速减少，我们试图评估艾滋病病毒阳性患者对病毒载量和CD4细胞计数检测的支付意愿（WTP），并确定可能为未来的共同支付计划提供参考的因素。
在河内和南定对1133名接受抗逆转录病毒治疗（ART）的艾滋病病毒阳性患者进行了多地点横断面调查。评估了患者的医疗保险覆盖情况、生活质量和非法药物使用史。采用条件估值法来衡量患者对CD4细胞计数和病毒载量检测的支付意愿。
在省级医疗机构接受抗逆转录病毒治疗的艾滋病病毒阳性患者报告称，在获得医疗保险（HI）方面困难更大，总体生活质量最差。大多数患者（90.9%）愿意支付CD4细胞计数检测费用；在此，每次检测的平均支付意愿估值为8.2美元（95%置信区间 = 7.6 - 8.8美元）。大多数患者（87.3%）也愿意支付病毒载量检测费用；在此，每次检测的平均支付意愿估值为18.6美元（95%置信区间 = 16.3 - 20.9美元）。高收入、高教育水平和住院与支付意愿呈正相关，而合并精神症状和支付医疗保险困难均与支付意愿呈负相关。
这些发现引发了人们对越南艾滋病病毒阳性患者对CD4细胞计数和病毒载量检测支付意愿可能较低的担忧。这意味着如果没有外国财政补贴，许多此类患者可能无法进行这些重要检测。治疗合并的精神疾病、促进医疗服务利用以及消除获得医疗保险的障碍，可能会提高越南艾滋病病毒阳性患者对艾滋病治疗监测的支付意愿。
