Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, California, USA
Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
BMJ Open. 2020 Feb 12;10(2):e032652. doi: 10.1136/bmjopen-2019-032652.
As HIV-positive individuals' life expectancy extends, there is an urgent need to manage other chronic conditions during HIV care. We assessed the care-seeking experiences and costs of adults receiving treatment for both HIV and hypertension in Malawi.
DESIGN, SETTING AND PARTICIPANTS: A cross-sectional survey was conducted with HIV-positive adults with hypertension at a health facility in Lilongwe that offers free HIV care and free hypertension screening, with antihypertensives available for purchase (n=199). Questions included locations and costs of all medication refills and preferences for these refill locations. Respondents were classified as using 'integrated care' if they refilled HIV and antihypertensive medications simultaneously. Data were collected between June and December 2017.
Only half of respondents reported using the integrated care offered at the study site. Among individuals using different locations for antihypertensive medication refills, the most frequent locations were drug stores and public sector health facilities which were commonly selected due to greater convenience and lower medication costs. Although the number of antihypertensive medications was equivalent between the integrated and non-integrated care groups, the annual total cost of care differed substantially (approximately US$21 in integrated care vs US$90 for non-integrated care)-mainly attributable to differences in other visit costs for non-integrated care (transportation, lost wages, childcare). One-third of those in the non-integrated care group reported no expenditure for antihypertensive medication, and six people in each group reported no annual hypertension care-seeking costs at all.
Individuals using integrated care saw efficiencies because, although they were more likely to pay for antihypertensive medications, they did not incur additional costs. These results suggest that preferences and experiences must be better understood to design effective policies and programmes for integrated care among adults on antiretroviral therapy.
随着 HIV 阳性个体的预期寿命延长，在进行 HIV 护理时迫切需要管理其他慢性疾病。我们评估了在马拉维的一个卫生机构接受 HIV 和高血压双重治疗的成年人的寻医经历和费用。
设计、地点和参与者：在利隆圭的一个提供免费 HIV 护理和免费高血压筛查的卫生机构中，对患有高血压的 HIV 阳性成年人进行了一项横断面调查，该机构提供的降压药可购买（n=199）。问题包括所有药物续药的地点和费用，以及对这些续药地点的偏好。如果患者同时续 HIV 和抗高血压药物，则将其归类为使用“综合护理”。数据收集于 2017 年 6 月至 12 月之间。
只有一半的受访者报告使用了研究点提供的综合护理。在因便利性和较低的药物费用而选择药物商店和公共部门卫生机构等不同地点续药的患者中，在因便利性和较低的药物费用而选择药物商店和公共部门卫生机构等不同地点续药的患者中，只有一半的受访者报告使用了研究点提供的综合护理。在使用不同地点续药的患者中，最常见的地点是药物商店和公共部门卫生机构。尽管综合护理和非综合护理组的抗高血压药物数量相同，但护理总成本差异很大（综合护理组每年约 21 美元，而非综合护理组每年约 90 美元）-主要归因于非综合护理组的其他就诊费用差异（交通、工资损失、儿童保育）。非综合护理组中有三分之一的人报告没有抗高血压药物支出，每组中有六个人根本没有支付年度高血压治疗费用。
使用综合护理的患者效率更高，因为虽然他们更有可能支付抗高血压药物的费用，但他们不会产生额外的费用。这些结果表明，必须更好地了解患者的偏好和经验，以设计针对接受抗逆转录病毒治疗的成年人的综合护理的有效政策和方案。
