ICAP at Columbia University, New York, NY, United States of America.
U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe.
PLoS One. 2021 Aug 18;16(8):e0256291. doi: 10.1371/journal.pone.0256291. eCollection 2021.
Zimbabwe has made large strides in addressing HIV. To ensure a continued robust response, a clear understanding of costs associated with its HIV program is critical. We conducted a cross-sectional evaluation in 2017 to estimate the annual average patient cost for accessing Prevention of Mother-To-Child Transmission (PMTCT) services (through antenatal care) and Antiretroviral Treatment (ART) services in Zimbabwe. Twenty sites representing different types of public health facilities in Zimbabwe were included. Data on patient costs were collected through in-person interviews with 414 ART and 424 PMTCT adult patients and through telephone interviews with 38 ART and 47 PMTCT adult patients who had missed their last appointment. The mean and median annual patient costs were examined overall and by service type for all participants and for those who paid any cost. Potential patient costs related to time lost were calculated by multiplying the total time to access services (travel time, waiting time, and clinic visit duration) by potential earnings (US$75 per month assuming 8 hours per day and 5 days per week). Mean annual patient costs for accessing services for the participants was US$20.00 [standard deviation (SD) = US$80.42, median = US$6.00, range = US$0.00-US$12,18.00] for PMTCT and US$18.73 (SD = US$58.54, median = US$8.00, range = US$0.00-US$ 908.00) for ART patients. The mean annual direct medical costs for PMTCT and ART were US$9.78 (SD = US$78.58, median = US$0.00, range = US$0.00-US$ 90) and US$7.49 (SD = US$60.00, median = US$0.00) while mean annual direct non-medical cost for US$10.23 (SD = US$17.35, median = US$4.00) and US$11.23 (SD = US$25.22, median = US$6.00, range = US$0.00-US$ 360.00). The PMTCT and ART costs per visit based on time lost were US$3.53 (US$1.13 to US$8.69) and US$3.43 (US$1.14 to US$8.53), respectively. The mean annual patient costs per person for PMTCT and ART in this evaluation will impact household income since PMTCT and ART services in Zimbabwe are supposed to be free.
津巴布韦在应对艾滋病方面取得了重大进展。为了确保持续采取强有力的应对措施，明确了解与艾滋病毒规划相关的成本至关重要。我们于 2017 年进行了一项横断面评估，以估计津巴布韦获得预防母婴传播（通过产前护理）和抗逆转录病毒治疗（ART）服务的年度平均患者成本。该研究纳入了津巴布韦 20 个不同类型的公共卫生机构。通过对 414 名接受抗逆转录病毒治疗的成年患者和 424 名接受预防母婴传播的成年患者进行面对面访谈，以及对 38 名错过上次预约的接受抗逆转录病毒治疗的成年患者和 47 名接受预防母婴传播的成年患者进行电话访谈，收集了患者成本数据。对所有参与者和支付任何费用的参与者，分别按服务类型检查了年度患者平均成本和中位数。通过将获得服务的总时间（旅行时间、等待时间和诊所就诊时间）乘以潜在收入（假设每天 8 小时，每周 5 天，为 75 美元/月），计算与时间损失相关的潜在患者成本。接受服务的参与者接受预防母婴传播服务的年度患者平均费用为 20.00 美元（标准差=80.42 美元，中位数=6.00 美元，范围=0.00-1218.00 美元），接受抗逆转录病毒治疗的患者为 18.73 美元（标准差=58.54 美元，中位数=8.00 美元，范围=0.00-908.00 美元）。预防母婴传播和抗逆转录病毒治疗的年度直接医疗费用平均值分别为 9.78 美元（标准差=78.58 美元，中位数=0.00 美元，范围=0.00-90 美元）和 7.49 美元（标准差=60.00 美元，中位数=0.00 美元），而年度直接非医疗费用平均值分别为 10.23 美元（标准差=17.35 美元，中位数=4.00 美元）和 11.23 美元（标准差=25.22 美元，中位数=6.00 美元，范围=0.00-360.00 美元）。基于时间损失的预防母婴传播和抗逆转录病毒治疗每次就诊的费用分别为 3.53 美元（1.13-8.69 美元）和 3.43 美元（1.14-8.53 美元）。在这项评估中，预防母婴传播和抗逆转录病毒治疗的每位患者每年的费用将影响家庭收入，因为津巴布韦的预防母婴传播和抗逆转录病毒治疗服务应该是免费的。
