Catastrophic Health Expenditure amongst People Living with HIV/AIDS Availing Antiretroviral Treatment Services at Two Tertiary Care Health Facilities in District of Northern India
Mukesh Shukla, Monika Agarwal, Jai Vir Singh, Anil Kumar Tripathi, Anand Kumar Srivastava, Vijay Kumar Singh.
"Introduction: Prevention with a positive approach and provision of free ART services has been advocated as one of the main strategies to diminish the new instances of HIV and betterment of the quality of life of PLHA. But in spite of those, out-of-pocket payments remain to be one of the main obstacles in the path of this approach. The present study aimed to estimate the out of pocket expenditure incurred and the various factors determining catastrophic health expenditure while receiving ART services.
Methods: A hospital based cross sectional study was conducted at two tertiary care hospitals of Lucknow for a period of six months. A total of 322 HIV-positive patients were interviewed face to face about their various expenses during the visit to ART centre.
Result: Mean out of pocket expenditure of the patients attending ART centre INR 312.26 ± 20.06. Catastrophic out-of-pocket expenditure incurred in about one-fifth (16.1%) patients attending the ART centre. Multiple logistic regression revealed distance travelled more than hundred kilometres to reach ART centre (OR 9.59; 95% CI 1.4364.267; p = 0.02) and lower socioeconomic class (OR 10.31; 95% CI 2.3044.58; p = 0.00) were found to be independent predictors of catastrophic out-of-pocket expenditure.
Conclusions: Decentralisation of ART programme up to grass root level, integration of HIV/AIDS-related services into primary health care services and bridging of the loop holes like effective convening of various government benefit schemes to patients during their visit to ART centre and there by promoting utilisation could reduce their financial burden for care and treatment."
Key words: PLHA (People living with HIV/AIDS), Antiretroviral Therapy, Out-of-pocket expenditure, Catastrophic health expenditure