Avoidable workload of care for patients living with HIV infection in Abidjan, Côte d’Ivoire: A cross-sectional study

Abstract

ObjectivePeople living with HIV infection (PLWHIV) in Sub-Saharan Africa cope with an increasing workload of care (doctor visits, lab tests, medication management, refills, etc.) in a context of poor health service organization. We aimed to describe the workload of care for PLWHIV in Sub-Saharan Africa and assess to what extent simple adjustments in care organization could reduce this workload of care.MethodsAdult PLWHIV under antiretroviral treatment for at least 1 year were recruited in three centers (two public, one private) in Abidjan, Côte d’Ivoire. Using methods inspired from sociology, we precisely described all health-related activities (HRAs) performed by patients, in 1 month, in terms of time, money and opportunity costs. Then, we assessed the theoretical avoidable workload of care if patients’ visits and tests had been grouped on the same days.ResultsWe enrolled 476 PLWHIV in the study. Patients devoted 6.7 hours (SD = 6.3), on average, in HRAs per month and spent 5% (SD = 11) of their monthly revenue, on average, on health activities. However, we found great inter-patient heterogeneity in the mixture of activities performed (managing medications; dietary recommendations; visits, tests, support groups; administrative tasks; etc.) and their time allocation, temporal dispersion and opportunity costs (personal, familial, social or professional costs). For 22% of patients, grouping activities on the same days could reduce both time and cost requirements by 20%.ConclusionPLWHIV in Côte d’Ivoire have a heavy workload of care. Grouping visits and tests on the same days may be a simple and feasible way to reduce patients’ investment of time and money in their care.

Patients’ perspectives on how to decrease the burden of treatment: a qualitative study of HIV care in sub-Saharan Africa

“…We invited all patients from the ANRS 12365 MOTUHS-BOT project,4 a cross-sectional study describing the workload of care for PLWH in sub-Saharan Africa, to share their ideas on how to decrease their burden of treatment during a qualitative study. Participants from the MOTUHS-BOT project were consecutive adults (age >18 years old), under ART treatment for at least 1 year, who attended consultation in three care centres in two districts (Treichville and Yopougon) of Abidjan, Côte d’Ivoire.…”

“…During meetings, the investigators compared their findings and reached consensus to create a taxonomy of participants’ propositions. Consensus was informed by the investigators’ previous works on the burden of treatment and their clinical experience 4 5. Finally, one investigator (VTT) reread participants’ contributions to assess consistency with the defined taxonomy.…”

“…Patients living with HIV infection (PLWH) in sub-Saharan Africa face many barriers in their care: out-of-pocket expenses, time spent travelling and attending clinical appointments, stigma and fear of disclosure, drug stock-outs, and so on 1–3. All these barriers contribute to worsening their burden of treatment, defined as the impact of everything they have to do to care for themselves on their quality of life and well-being 4–6. It is critical for health professionals to consider PLWH’s burden of treatment.…”

“…Indeed, whenever patients’ healthcare tasks compete with other meaningful life demands, patients weigh the expected benefits of pursuing the healthcare against the associated burden of treatment and may intentionally decide not to adhere to care 1 5 7–9. This could lead to viral resistance to antiretroviral therapy (ART),4 10 11 virological failure,12 13 risk for others and increased mortality.…”