Geldsetzer Pascal, Sauer Alexander, Francis Joel M, Mboggo Eric, Lwezaula Sharon, Sando David, Fawzi Wafaie, Ulenga Nzovu, Bärnighausen Till
Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305, USA.
Heidelberg Institute of Global Health (HIGH), Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
Health Policy Plan. 2021 Feb 16;35(10):1300-1308. doi: 10.1093/heapol/czaa088.
Community health worker (CHW)-led community delivery of HIV antiretroviral therapy (ART) could increase ART coverage and decongest healthcare facilities. It is unknown how much patients would be willing to pay to receive ART at home and, thus, whether ART community delivery could be self-financing. Set in Dar es Salaam, this study aimed to determine patients' willingness to pay (WTP) for CHW-led ART community delivery. We sampled ART patients living in the neighbourhoods surrounding each of 48 public-sector healthcare facilities in Dar es Salaam. We asked participants (N = 1799) whether they (1) preferred ART community delivery over standard facility-based care, (2) would be willing to pay for ART community delivery and (3) would be willing to pay each of an incrementally increasing range of prices for the service. 45.0% (810/1799; 95% CI: 42.7-47.3) of participants preferred ART community delivery over standard facility-based care and 51.5% (417/810; 95% CI: 48.1-55.0) of these respondents were willing to pay for ART community delivery. Among those willing to pay, the mean and median amount that participants were willing to pay for one ART community delivery that provides a 2-months' supply of antiretroviral drugs was 3.61 purchasing-power-parity-adjusted dollars (PPP$) (95% CI: 2.96-4.26) and 1.27 PPP$ (IQR: 1.27-2.12), respectively. An important limitation of this study is that participants all resided in neighbourhoods within the catchment area of the healthcare facility at which they were interviewed and, thus, may incur less costs to attend standard facility-based ART care than other ART patients in Dar es Salaam. While there appears to be a substantial WTP, patient payments would only constitute a minority of the costs of implementing ART community delivery. Thus, major co-financing from governments or donors would likely be required.
由社区卫生工作者主导的社区层面的艾滋病病毒抗逆转录病毒疗法（ART）服务，有望提高抗逆转录病毒疗法的覆盖范围，并缓解医疗机构的压力。目前尚不清楚患者愿意支付多少费用在家中接受抗逆转录病毒疗法，因此，社区层面的抗逆转录病毒疗法服务是否能够实现自筹资金也未可知。本研究以达累斯萨拉姆为背景，旨在确定患者对由社区卫生工作者主导的社区层面抗逆转录病毒疗法服务的支付意愿（WTP）。我们对居住在达累斯萨拉姆48家公共部门医疗机构周边社区的抗逆转录病毒疗法患者进行了抽样。我们询问参与者（N = 1799）：（1）相较于标准的基于医疗机构的护理，他们是否更倾向于社区层面的抗逆转录病毒疗法服务；（2）是否愿意为社区层面的抗逆转录病毒疗法服务付费；（3）是否愿意为该服务支付一系列逐步递增的价格。45.0%（810/1799；95%置信区间：42.7 - 47.3）的参与者相较于标准的基于医疗机构的护理，更倾向于社区层面的抗逆转录病毒疗法服务，在这些受访者中，51.5%（417/810；95%置信区间：48.1 - 55.0）愿意为社区层面的抗逆转录病毒疗法服务付费。在愿意付费的人群中，参与者为一次提供两个月抗逆转录病毒药物供应量的社区层面抗逆转录病毒疗法服务愿意支付的平均金额和中位数金额分别为3.61购买力平价调整美元（PPP$）（95%置信区间：2.96 - 4.26）和1.27 PPP$（四分位距：1.27 - 2.12）。本研究的一个重要局限性在于，参与者均居住在他们接受访谈的医疗机构服务范围内的社区，因此，相较于达累斯萨拉姆的其他抗逆转录病毒疗法患者，他们前往标准的基于医疗机构的抗逆转录病毒疗法护理的成本可能更低。虽然似乎存在相当大的支付意愿，但患者支付的费用仅占实施社区层面抗逆转录病毒疗法服务成本的一小部分。因此，可能需要政府或捐助者提供大量的共同资助。
