Assebe Lelisa Fekadu, Negussie Eyerusalem Kebede, Jbaily Abdulrahman, Tolla Mieraf Taddesse Taddesse, Johansson Kjell Arne
Department Of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
Disease Prevention and Control, Ministry of Health, Addis Ababa, Ethiopia.
BMJ Open. 2020 Jun 1;10(6):e036892. doi: 10.1136/bmjopen-2020-036892.
HIV and tuberculosis (TB) are major global health threats and can result in household financial hardships. Here, we aim to estimate the household economic burden and the incidence of catastrophic health expenditures (CHE) incurred by HIV and TB care across income quintiles in Ethiopia.
A cross-sectional survey.
27 health facilities in Afar and Oromia regions for TB, and nationwide household survey for HIV.
A total of 1006 and 787 individuals seeking HIV and TB care were enrolled, respectively.
The economic burden (ie, direct and indirect cost) of HIV and TB care was estimated. In addition, the CHE incidence and intensity were determined using direct costs exceeding 10% of the household income threshold.
The mean (SD) age of HIV and TB patient was 40 (10), and 30 (14) years, respectively. The mean (SD) patient cost of HIV was $78 ($170) per year and $115 ($118) per TB episode. Out of the total cost, the direct cost of HIV and TB constituted 69% and 46%, respectively. The mean (SD) indirect cost was $24 ($66) per year for HIV and $63 ($83) per TB episode. The incidence of CHE for HIV was 20%; ranges from 43% in the poorest to 4% in the richest income quintile (p<0.001). Similarly, for TB, the CHE incidence was 40% and ranged between 58% and 20% among the poorest and richest income quintiles, respectively (p<0.001). This figure was higher for drug-resistant TB (62%).
HIV and TB are causes of substantial economic burden and CHE, inequitably, affecting those in the poorest income quintile. Broadening the health policies to encompass interventions that reduce the high cost of HIV and TB care, particularly for the poor, is urgently needed.
艾滋病毒和结核病是全球主要的健康威胁，可导致家庭经济困难。在此，我们旨在估计埃塞俄比亚不同收入五分位数人群因艾滋病毒和结核病治疗而产生的家庭经济负担以及灾难性卫生支出（CHE）的发生率。
横断面调查。
阿法尔和奥罗米亚地区的27家结核病治疗卫生机构，以及全国范围的艾滋病毒家庭调查。
分别纳入了1006名寻求艾滋病毒治疗和787名寻求结核病治疗的个体。
估计艾滋病毒和结核病治疗的经济负担（即直接和间接成本）。此外，使用超过家庭收入阈值10%的直接成本来确定CHE的发生率和强度。
艾滋病毒和结核病患者的平均（标准差）年龄分别为40（10）岁和30（14）岁。艾滋病毒患者的平均（标准差）每年费用为78美元（170美元），每例结核病发作的费用为115美元（118美元）。在总成本中，艾滋病毒和结核病的直接成本分别占69%和46%。艾滋病毒的平均（标准差）间接成本为每年24美元（66美元），每例结核病发作的间接成本为63美元（83美元）。艾滋病毒的CHE发生率为20%；在最贫困的收入五分位数人群中为43%，在最富有的收入五分位数人群中为4%（p<0.001）。同样，对于结核病，CHE发生率为40%，在最贫困和最富有的收入五分位数人群中分别在58%和20%之间（p<0.001）。耐多药结核病的这一数字更高（62%）。
艾滋病毒和结核病是造成巨大经济负担和CHE的原因，且不公平地影响着最贫困收入五分位数人群。迫切需要扩大卫生政策，纳入降低艾滋病毒和结核病治疗高昂成本的干预措施，尤其是针对贫困人口的措施。
