Cost to patients of obtaining treatment for HIV/AIDS in South Africa

Background. South Africa is providing antiretroviral (ARV) drugs for HIV I AIDS free of charge in order to increase access for poorer patients and promote adherence. However, non-drug costs of obtaining treatment may limit access. We estimated the costs that South African patients incur in obtaining antiretroviral therapy (ART).Methods. A random sample of adult pre-ART and ART patients attending a public urban hospital (site 1), a peri-urban (informal settlement) non-governmental organisation (NGO) clinic (site 2), and a rural NGO clinic (site 3) were interviewed during a routine clinic visit. Mean and median costs were calculated for each site.Results. Ninety-one per cent of subjects paid for transport to attend the clinic. The median cost was modest (R10- R28), but patients in the top decile at sites 1 and 3 paid RSO or more. Mean transport costs were substantially higher at site 1 (R75) than at site 2 (R18) or Site 3 (R47). Site 1 waived its R45 visit fee for most subjects, but more than 80% of subjects at sites 2 and 3 paid fees of R30 and R70, respectively. Few subjects at any site paid for substitute labour (7%) or suffered income loss (12%) during the visit. In the previous week, 60% of all subjects purchased non-prescription medicines or special foods, at a median cost of R81, R45 and RSO for sites 1, 2 and 3, respectively. The upper quartile of patients paid more than R150 for these purchases. Twelve per cent of patients reported paying for other medical care in the previous week, while 48% said that they had utilised caretakers' time.Conclusions. Patients must visit a treatment clinic at least 6 times in the year in which they start ART. The average cost per visit is R120, plus travel and waiting time. Patients and caregivers also spend considerable time and money between visits. Patient costs should be considered in efforts to sustain adherence and expand access

Economic Outcomes of Patients Receiving Antiretroviral Therapy for HIV/AIDS in South Africa Are Sustained through Three Years on Treatment

BACKGROUND. Although the medical outcomes of antiretroviral therapy (ART) for HIV/AIDS are well described, less is known about how ART affects patients' economic activities and quality of life, especially after the first year on ART. We assessed symptom prevalence, general health, ability to perform normal activities, and employment status among adult antiretroviral therapy patients in South Africa over three full years following ART initiation. METHODOLOGY/PRINCIPAL FINDINGS. A cohort of 855 adult pre-ART patients and patients on ART for <6 months was enrolled and interviewed an average of 4.4 times each during routine clinic visits for up to three years after treatment initiation using an instrument designed for the study. The probability of pain in the previous week fell from 74% before ART initiation to 32% after three years on ART, fatigue from 66% to 12%, nausea from 28% to 4%, and skin problems from 55% to 10%. The probability of not feeling well physically yesterday fell from 46% to 23%. Before starting ART, 39% of subjects reported not being able to perform their normal activities sometime during the previous week; after three years, this proportion fell to 10%. Employment rose from 27% to 42% of the cohort. Improvement in all outcomes was sustained over 3 years and for some outcomes increased in the second and third year. CONCLUSIONS/SIGNIFICANCE. Improvements in adult ART patients' symptom prevalence, general health, ability to perform normal activities, and employment status were large and were sustained through the first three years on treatment. These results suggest that some of the positive economic and social externalities anticipated as a result of large-scale treatment provision, such as increases in workforce participation and productivity and the ability of patients to carry on normal lives, may indeed be accruing.South Africa Mission of the U.S. Agency for International Development (GHSA-00-00020-00, 674-A-00-09-00018-00, 674-A-00-02-00018); National Institute of Allergies and Infectious Diseases (PEPFAR 13, K01AI083097); APDA Advanced Center for Parkinson Research at UAB (NIH F30NS065661, NIH R01CA122930); National Institutes of Health Blueprint Core for Neuroscience Research (NS057098

Probability of being unable to perform normal activities last week and of employment by time on ART.

<p>Probability of being unable to perform normal activities last week and of employment by time on ART.</p

Reference probability and marginal effects of feeling unwell on day before interview (logistic regression, population averaged model).

<p>*Reference case is a female subject age 30–39, 0–30 days on ART.</p>a<p>Indicates p-value ≤0.05 for Wald test that marginal effect equals marginal effect for 271–360 days on ART.</p>b<p>Indicates p-value >0.05 for Wald test that marginal effect equals marginal effect for 271–360 days on ART.</p

Characteristics of cohort at baseline.

<p>Characteristics of cohort at baseline.</p

Reference probability and marginal effects of experiencing pain or fatigue during the previous week (logistic regression, population averaged model).

<p>*Reference case is a female subject age 30–39, 1–30 days on ART.</p>a<p>Indicates p-value ≤0.05 for Wald test that marginal effect equals marginal effect for 271–360 days on ART.</p>b<p>Indicates p-value >0.05 for Wald test that marginal effect equals marginal effect for 271–360 days on ART.</p