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. 2019 Jun 7:43:e56.
doi: 10.26633/RPSP.2019.56. eCollection 2019.

Out-of-pocket expenditures for HIV in the Dominican Republic: findings from a community-based participatory survey

Claire Chaumont  1 , Carlo Oliveira  2 , Enrique Chavez  3 , Jaime Valencia  3 , Pablo Villalobos Dintrans  4
Affiliations

Out-of-pocket expenditures for HIV in the Dominican Republic: findings from a community-based participatory survey

Claire Chaumont et al. Rev Panam Salud Publica. .

Abstract
in English, Spanish, Portuguese

Objectives: The aim of this study was to estimate out-of-pocket expenditures incurred by individuals with HIV in the Dominican Republic. The study utilized different definitions and components for these expenditures and differentiated the results by wage ranges.

Methods: Data was obtained from an in-person survey of people living with HIV. The study was developed and implemented in collaboration with Dominican grassroots organizations and networks of people with HIV, through a process of community-based participatory research.

Results: The mean HIV-related expenditure reported by individuals in the sample in the last six months prior to the survey was in US$ 181; 15.4% of this total was spent for transportation and housing and costs to access the HIV facility. The mean expenditure reported by individuals for their current visit to an HIV center was US$ 10. These out-of-pocket expenditures exhibited regressivity, with lower-wage patients spending proportionally more to receive care. The results highlight the importance of considering other resources required to access treatment, such as lodging expenses and the time needed to travel to an HIV center and then to wait to be seen by a care provider.

Conclusions: There should be more focus on expenditures made directly by people with HIV in the Dominican Republic so that these payments do not become a barrier to accessing health care. Using a community-based participatory design can ensure that such data can be leveraged to address the specific barriers to care that are faced by individuals with HIV.

Objetivos: El objetivo de este estudio fue estimar los gastos directos de bolsillo que enfrentan las personas con VIH en la República Dominicana, utilizando diferentes definiciones y componentes para estos gastos y desglosando los resultados por rangos salariales.

Métodos: Los datos se obtuvieron a partir de una encuesta presencial a personas con infección por el VIH. El estudio se llevó a cabo en colaboración con organizaciones comunitarias locales y redes de personas con infección por el VIH, mediante un proceso de investigación participativa comunitaria.

Resultados: El gasto directo promedio en los seis meses anteriores a la encuesta para las personas con VIH que conformaban la muestra fue de US$ 181; el 15,4% del gasto directo total se dedicó a transporte, vivienda y otros costos para acceder al establecimiento de salud. El gasto promedio informado por las personas para su cita actual en el establecimiento de salud fue de US$ 10. El gasto directo presentó regresividad: los pacientes de salario inferior gastaban proporcionalmente más para recibir atención. Los resultados destacan la importancia de considerar otros recursos necesarios para obtener acceso al tratamiento, como los gastos de alojamiento y el tiempo invertido en desplazarse a un centro de atención del VIH y esperar a ser atendido por un prestador de atención.

Conclusiones: Es necesario centrar más la atención en el gasto directo de las personas con VIH en la República Dominicana, para que estos costos no se conviertan en un obstáculo al acceso a la atención de salud. Un enfoque participativo comunitario propiciaría el uso de estos datos para abordar los obstáculos específicos que enfrentan las personas con VIH a la hora de obtener atención.

Objetivos: Estimar as despesas desembolsadas por pessoas com HIV na República Dominicana segundo diferentes definições e itens para estas despesas e a diferenciação dos resultados por faixas salariais.

Métodos: Os dados foram obtidos em uma pesquisa presencial com pessoas com HIV. O estudo foi elaborado e executado em colaboração com organizações locais dominicanas e redes de pessoas com HIV por meio de um processo da pesquisa participativa baseada na comunidade.

Resultados: A despesa média relacionada ao HIV nos seis meses anteriores à pesquisa informada pelos participantes na amostra estudada foi de US$ 181, sendo que 15,4% deste montante foram gastos com transporte e moradia e custos de acesso ao serviço de HIV. A despesa média informada pelos participantes para a consulta corrente ao centro de assistência de HIV foi de US$ 10. A despesa desembolsada apresentou regressividade, com os pacientes pertencentes à faixa de menor salário gastando proporcionalmente mais para obter atendimento. Estes resultados indicam a importância de considerar outros recursos necessários para obter acesso ao tratamento, como despesas de alojamento e o tempo necessário para ir a um centro de assistência de HIV e aguardar o atendimento por um profissional.

Conclusões: É preciso atentar mais às despesas incorridas diretamente pelas pessoas com HIV para que estes gastos não se convertam em barreiras ao acesso à assistência de saúde na República Dominicana. O design participativo baseado na comunidade do estudo permite que os dados sejam aproveitados para examinar as barreiras específicas ao atendimento de saúde enfrentadas por pessoas com HIV.

Keywords: Dominican Republic; HIV; community-based participatory research; health care costs; health expenditures.

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Conflict of interest statement

Conflicts of interest. The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1. Distribution of out-of-pocket expenditures across different HIV-related services in the preceding six months among survey participants, expressed as a percentage, Dominican Republic, 2015.
See this image and copyright information in PMC

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