Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, 1025 E. 7th St, Bloomington, IN, 47405, USA.
Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany.
BMC Public Health. 2023 Nov 8;23(1):2202. doi: 10.1186/s12889-023-17043-2.
Studies from rural South Africa indicate that people living with HIV (PLHIV) may have better health outcomes than those without, potentially due to the frequent healthcare visits necessitated by infection. Here, we examined the association between HIV status and healthcare utilization, using diabetes as an illustrative comparator of another high-burden, healthcare-intensive disease.
Our exposure of interest was awareness of positive disease status for both HIV and diabetes. We identified 742 individuals who were HIV-positive and aware of their status and 305 who had diabetes and were aware of their status. HIV-positive status was further grouped by viral suppression. For each disease, we estimated the association with (1) other comorbid, chronic conditions, (2) health facility visits, (3) household-level healthcare expenditure, and (4) per-visit healthcare expenditure. We used log-binomial regression models to estimate prevalence ratios for co-morbid chronic conditions. Linear regression models were used for all other outcomes.
Virally suppressed PLHIV had decreased prevalence of chronic conditions, increased public clinic visits [β = 0.59, 95% CI: 0.5, 0.7], and reduced per-visit private clinic spending [β = -60, 95% CI: -83, -6] compared to those without HIV. No differences were observed in hospitalizations and per-visit spending at hospitals and public clinics between virally suppressed PLHIV and non-PLHIV. Conversely, diabetic individuals had increased prevalence of chronic conditions, increased visits across facility types, increased household-level expenditures (β = 88 R, 95% CI: 29, 154), per-visit hospital spending (β = 54 R, 95% CI: 7, 155), and per-visit public clinic spending (β = 31 R, 95% CI: 2, 74) compared to those without diabetes.
Our results suggest that older adult PLHIV may visit public clinics more often than their HIV-negative counterparts but spend similarly on a per-visit basis. This provides preliminary evidence that the positive health outcomes observed among PLHIV in rural South Africa may be explained by different healthcare engagement patterns. Through our illustrative comparison between PLHIV and diabetics, we show that shifting disease burdens towards chronic and historically underfunded diseases, like diabetes, may be changing the landscape of health expenditure inequities.
来自南非农村的研究表明，感染艾滋病毒（HIV）的人可能比未感染者的健康状况更好，这可能是由于感染需要频繁的医疗保健访问。在这里，我们研究了 HIV 感染状况与医疗保健利用之间的关系，以糖尿病作为另一种高负担、需要大量医疗保健的疾病的对照。
我们感兴趣的暴露因素是 HIV 和糖尿病的阳性疾病意识。我们确定了 742 名 HIV 阳性且知晓其状况的个体和 305 名患有糖尿病且知晓其状况的个体。进一步按病毒抑制情况对 HIV 阳性状况进行分组。对于每种疾病，我们评估了与以下方面的关联：（1）其他合并的慢性疾病，（2）卫生机构就诊，（3）家庭医疗支出，以及（4）每次就诊的医疗支出。我们使用对数二项式回归模型来估计合并慢性疾病的患病率比。所有其他结果均使用线性回归模型进行分析。
病毒抑制的 PLHIV 慢性疾病患病率较低，公共诊所就诊次数增加[β=0.59，95%置信区间：0.5，0.7]，每次就诊的私人诊所支出减少[β=-60，95%置信区间：-83，-6]，与未感染 HIV 的人相比。病毒抑制的 PLHIV 与非 PLHIV 之间在住院和各医疗机构就诊的每次就诊费用方面没有差异。相反，糖尿病患者的慢性疾病患病率增加，各医疗机构就诊次数增加，家庭医疗支出增加（β=88 R，95%置信区间：29，154），每次就诊的医院支出增加（β=54 R，95%置信区间：7，155），每次就诊的公共诊所支出增加（β=31 R，95%置信区间：2，74），与未患糖尿病的人相比。
我们的研究结果表明，老年 HIV 感染者可能比未感染 HIV 的人更频繁地到公共诊所就诊，但每次就诊的费用相似。这初步证明，在南非农村地区观察到的 HIV 感染者的积极健康结果可能是由于不同的医疗保健参与模式所致。通过对 PLHIV 和糖尿病患者的对比，我们表明，将疾病负担向糖尿病等慢性和历史上资金不足的疾病转移，可能正在改变卫生支出不平等的格局。
