Cameron Drew B, Morrell Lillian C, Kagoya Faith, Kiggundu John Baptist, Hutchinson Brian, Twine Robert, Schwartz Jeremy I, Muddu Martin, Mutungi Gerald, Kayima James, Katahoire Anne R, Longenecker Chris T, Nugent Rachel, Loya David Contreras, Semitala Fred C
Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America.
Center for Global Noncommunicable Diseases, RTI International, Seattle, Washington, United States of America.
PLOS Glob Public Health. 2024 Sep 25;4(9):e0003423. doi: 10.1371/journal.pgph.0003423. eCollection 2024.
Despite improvements to the cascade of HIV care in East Africa, access to care for non-communicable disease co-morbidities like hypertension (HTN) remains a persistent problem. The integration of care for these conditions presents an opportunity to achieve efficiencies in delivery as well as decrease overall costs for patients. This study aims to build evidence on the burden of current out-of-pocket costs of care among HIV-HTN co-morbid patients.
We administered a pre-tested, cross-sectional, out-of-pocket cost survey to 94 co-morbid patients receiving HIV care from 10 clinics in the Wakiso and Kampala districts of Uganda from June to November 2021. The survey assessed socio-demographic characteristics, direct medical costs (e.g., medications, consultations), indirect costs (e.g., transport, food, caregiving), and economic costs (i.e., foregone income) associated with seeking HIV and HTN care, as well as possible predictors of monthly care costs. Patients were sampled both during a government-imposed nation-wide full COVID-19 lockdown (n = 30) and after it was partially lifted (n = 64).
Median HIV care costs constitute between 2.7 and 4.0% of median monthly household income, while HTN care costs are between 7.1 to 7.9%. For just under half of our sample, the median monthly cost of HTN care is more than 10% of household income, and more than a quarter of patients report borrowing money or selling assets to cover costs. We observe uniformly lower reported costs of care for both conditions under full COVID-19 lockdown, suggesting that access to care was limited. The main predictors of monthly HIV and HTN care costs varied by disease and costing perspective.
Patient out of pocket costs of care for HIV and HTN were substantial, but significantly lower during the 2021 full COVID-19 lockdown in Uganda. New strategies such as service integration need to be explored to reduce these costs.
尽管东非地区的艾滋病病毒护理流程有所改善，但获得高血压（HTN）等非传染性疾病合并症的护理仍然是一个长期存在的问题。整合这些疾病的护理提供了提高服务效率以及降低患者总体成本的机会。本研究旨在获取有关艾滋病病毒-高血压合并症患者当前自付护理费用负担的证据。
2021年6月至11月，我们对乌干达瓦基索区和坎帕拉区10家诊所的94名接受艾滋病病毒护理的合并症患者进行了一项经过预测试的横断面自付费用调查。该调查评估了社会人口学特征、直接医疗费用（如药物、会诊）、间接费用（如交通、食品、护理）以及与寻求艾滋病病毒和高血压护理相关的经济成本（即放弃的收入），以及每月护理费用的可能预测因素。患者在政府实施的全国范围全面新冠疫情封锁期间（n = 30）和部分解除封锁后（n = 64）均有抽样。
艾滋病病毒护理费用中位数占家庭月收入中位数的2.7%至4.0%，而高血压护理费用则在7.1%至7.9%之间。在我们的样本中，近一半患者的高血压护理月费用中位数超过家庭收入的10%，超过四分之一的患者报告为支付费用而借钱或变卖资产。我们观察到在全面新冠疫情封锁期间，两种疾病的报告护理费用均普遍较低，这表明获得护理的机会有限。每月艾滋病病毒和高血压护理费用的主要预测因素因疾病和成本核算角度而异。
艾滋病病毒和高血压患者的自付护理费用很高，但在2021年乌干达全面新冠疫情封锁期间显著降低。需要探索服务整合等新策略来降低这些成本。
