Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Nov 1;32(suppl_4):iv48-iv56.
doi: 10.1093/heapol/czw183.

The patient costs of care for those with TB and HIV: a cross-sectional study from South Africa

Don Mudzengi  1 , Sedona Sweeney  2 , Piotr Hippner  1 , Tendesayi Kufa  1 , Katherine Fielding  3 , Alison D Grant  4 , Gavin Churchyard  1 , Anna Vassall  2
Affiliations

The patient costs of care for those with TB and HIV: a cross-sectional study from South Africa

Don Mudzengi et al. Health Policy Plan. .

Abstract

Background: This study describes the post-diagnosis care-seeking costs incurred by people living with TB and/or HIV and their households, in order to identify the potential benefits of integrated care.

Methods: We conducted a cross-sectional study with 454 participants with TB or HIV or both in public primary health care clinics in Ekurhuleni North Sub-District, South Africa. We collected information on visits to health facilities, direct and indirect costs for participants and for their guardians and caregivers. We define 'integration' as receipt of both TB and HIV services at the same facility, on the same day. Costs were presented and compared across participants with TB/HIV, TB-only and HIV-only. Costs exceeding 10% of participant income were considered catastrophic.

Results: Participants with both TB and HIV faced a greater economic burden (US$74/month) than those with TB-only (US$68/month) or HIV-only (US$40/month). On average, people with TB/HIV made 18.4 visits to health facilities, more than TB-only participants or HIV-only participants who made 16 and 5.1 visits, respectively. However, people with TB/HIV had fewer standalone TB (10.9) and HIV (2.2) visits than those with TB-only (14.5) or HIV-only (4.4). Although people with TB/HIV had access to 'integrated' services, their time loss was substantially higher than for other participants. Overall, 55% of participants encountered catastrophic costs. Access to official social protection schemes was minimal.

Conclusions: People with TB/HIV in South Africa are at high risk of catastrophic costs. To some extent, integration of services reduces the number of standalone TB and HIV of visits to the health facility. It is however unlikely that catastrophic costs can be averted by service integration alone. Our results point to the need for timely social protection, particularly for HIV-positive people starting TB treatment.

Keywords: HIV; integration; patient costs; poverty; tuberculosis.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Catastrophic costs due to illness, by participant group
See this image and copyright information in PMC

References

    1. Alam K, Mahal A.. 2014. Economic impacts of health shocks on households in low and middle income countries: a review of the literature. Globalization and Health 10: 21. - PMC - PubMed
    1. Aspler A, Menzies D, Oxlade O. et al. 2008. Cost of tuberculosis diagnosis and treatment from the patient perspective in Lusaka, Zambia. The International Journal of Tuberculosis and Lung Disease 12: 928–35. - PubMed
    1. Atun R, de Jongh T, Secci F, Ohiri K, Adeyi O.. 2010. A systematic review of the evidence on integration of targeted health interventions into health systems. Health Policy and Planning 25: 1–14. - PubMed
    1. Barter DM, Agboola SO, Murray MB, Barnighausen T, Bärnighausen T.. 2012. Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa–a systematic review. BMC Public Health 12: 980.. - PMC - PubMed
    1. Bill and Melinda Gates Foundation, Health Intervention and Technology Assessment Programme, Centre for Health Economics, NICE International, Health Intervention and Technology Assessment Program (Thailand), University of York Centre for Health Economics. 2014. Bill and Melinda Gates Foundation Methods for Economic Evaluation Project (MEEP) Final Report