TransVIHMI, University of Montpellier, INSERM, Institut de Recherche pour le Développement, Montpellier, France
Centre Régional de Recherche et de Formation à la prise en charge Clinique de Fann, Dakar, Senegal.
BMJ Open. 2021 Jul 7;11(7):e046579. doi: 10.1136/bmjopen-2020-046579.
In Senegal, a national health coverage system named Couverture Medicale Universelle (CMU) has been under development since 2013; its impact on out-of-pocket (OOP) expenses for people living with HIV (PLHIV) remains unknown. Our objective was to assess the impact of the national health coverage system on health expenses for PLHIV by measuring the OOP amount for a routine consultation for various categories of PLHIV, in Dakar and different regions in Senegal, viewed from the patients' perspective.
DESIGN, SETTING AND PARTICIPANTS: Cross-sectional survey in 2018 and 2019 using a face-to-face questionnaire with PLHIV: 344 adults followed up at Fann Regional Centre for research and training in clinical treatment in Dakar; 60 adult men who have sex with men (MSM) in 2 hospitals in Dakar and 7 facilities in the regions; and 130 children and adolescents (0-19 years) in 16 care facilities in the southern regions. We have calculated the total price of the consultation and associated prescriptions along with the patient's OOP medical and transportation contributions. The average amounts were compared using the Student's t-test.
All patients are on antiretroviral treatment with a median duration of 6 years, 5 years and 3 years for adults, MSM and children/adolescents, respectively. The percentage of people who have health coverage is 26%, 18% and 44% for adults, MSM and children. In practice, these systems are rarely used. The OOP amount (health expenses+transportation costs) for a routine consultation is €11 for adults and children, and €32.5 for MSM.
The number of PLHIV with coverage is low, and the system's effectiveness remains limited. Currently, this system has proved ineffective in implementing free healthcare, recommended by WHO since 2005.
自 2013 年以来，塞内加尔一直在开发一项名为全民医疗保险（CMU）的国家医疗保险制度；其对艾滋病毒感染者（PLHIV）自付费用的影响尚不清楚。我们的目的是从患者的角度评估国家医疗保险制度对 PLHIV 健康费用的影响，通过衡量不同类别 PLHIV 进行常规就诊的自付金额，在达喀尔和塞内加尔不同地区进行调查。
设计、地点和参与者：2018 年和 2019 年进行了横断面调查，使用面对面问卷对 PLHIV 进行调查：达喀尔 Fann 区域中心研究和临床治疗培训中心的 344 名成年人；达喀尔 2 家医院和 7 家地区的 60 名男男性行为者（MSM）；以及南部地区 16 个护理机构的 130 名儿童和青少年（0-19 岁）。我们计算了咨询的总价格以及相关处方和患者的自付医疗和交通贡献。使用学生 t 检验比较平均值。
所有患者均接受抗逆转录病毒治疗，成人、MSM 和儿童/青少年的治疗中位持续时间分别为 6 年、5 年和 3 年。有医疗保险的人数分别为成年人、MSM 和儿童的 26%、18%和 44%。实际上，这些系统很少被使用。常规就诊的自付金额（医疗费用+交通费用）为成年人和儿童 11 欧元，MSM 为 32.5 欧元。
有医疗保险的 PLHIV 人数较少，该系统的效果仍然有限。目前，该系统在实施 2005 年世卫组织推荐的免费医疗保健方面效果不佳。
