Patient costs incurred by people living with HIV/AIDS prior to ART initiation in primary healthcare facilities in Gauteng, South Africa

Pillai, Natasha; Foster, Nicola; Hanifa, Yasmeen; Ndlovu, Nontobeko T.; Fielding, Katherine; Churchyard, Gavin J.; Chihota, Violet; Grant, Alison D.; Vassall, Anna

doi:10.1371/journal.pone.0210622

Cited by 12 publications

(8 citation statements)

References 25 publications

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“…These have been shown to affect patients accessing HIV/ AIDS care in South Africa. 39 Prior personal or community experience of costs for accessing medical care in South Africa may disincline people with TCC from seeking care. This may be a factor in explaining the large proportion of the deceased who did not seek any care in our study population.…”

Section: Discussionmentioning

confidence: 99%

Time-critical conditions: assessment of burden and access to care using verbal autopsy in Agincourt, South Africa

et al. 2020

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BackgroundTime-critical conditions (TCC) are estimated to cause substantial mortality in low and middle-income countries. However, quantification of deaths and identification of contributing factors to those deaths are challenging in settings with poor health records.AimTo use verbal autopsy (VA) data from the Agincourt health and sociodemographic surveillance system in rural South Africa to quantify the burden of deaths from TCC and to evaluate the barriers in seeking, reaching and receiving quality care for TCC leading to death.MethodologyDeaths from 1993 to 2015 were analysed to identify causality from TCC. Deaths due to TCC were categorised as communicable, non-communicable, maternal, neonatal or injury-related. Proportion of deaths from TCC by age, sex, condition type and temporal trends was described. Deaths due to TCC from 2012 to 2015 were further examined by circumstances of mortality (CoM) indicators embedded in VA. Healthcare access, at illness onset and during the final day of life, as well as place of death, was extracted from free text summaries. Summaries were also analysed qualitatively using a Three Delays framework to identify barriers to healthcare.ResultsOf 15 305 deaths, 5885 (38.45%) were due to TCC. Non-communicable diseases were the most prevalent cause of death from TCC (2961/5885 cases, 50.31%). CoM indicators highlighted delays in a quarter of deaths due to TCC, most frequently in seeking care. The most common pattern of healthcare access was to die outwith a facility, having sought no healthcare (409/1324 cases, 30.89%). Issues in receipt of quality care were identified by qualitative analysis.ConclusionTCCs are responsible for a substantial burden of deaths in this rural South African population. Delays in seeking and receiving quality care were more prominent than those in reaching care, and thus further research and solution development should focus on healthcare-seeking behaviour and quality care provision.

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Section: Discussionmentioning

confidence: 99%

Time-critical conditions: assessment of burden and access to care using verbal autopsy in Agincourt, South Africa

et al. 2020

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“…This information was used to calculate the wage losses generated by the visit. 24 A total hidden cost was measured in Ethiopian Birr and then converted to US dollars for the same year. Since the data were skewed to the right, the median was selected as cut off.…”

Section: Methodsmentioning

confidence: 99%

Hidden Costs of Hospital-Based Delivery Among Women Using Public Hospitals in Bale Zone, Southeast Ethiopia

Merga

Debela

Alaro

2019

J Prim Care Community Health

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Background: The Ethiopian health care system since 2005 has encouraged safe enhanced obstetrical care. However, hospital delivery has remained expensive for poor households due to hidden costs. Hidden costs are the costs that are not accounted for in direct hospital costs. The aim of this study was to estimate the hidden costs of institutional delivery and to identify its associated factors. Methods: A health facility–based cross-sectional study was conducted in the Bale zone from August 13 to September 2, 2018. Exit interviews were conducted among women who gave birth at the selected hospitals. A total of 390 women from 1 referral hospital and 2 general hospitals were included into the study. Systematic sampling technique was used to select study participants. Multiple linear regression analysis was done to identify the predictors of the hidden cost of institutional delivery. Result: The median hidden cost of institutional delivery was 877.5 ETB (32.03 USD). The median of the direct medical cost of normal delivery was 280 ETB (10.21 USD) while the direct nonmedical cost was 230 ETB (8.40 USD). For cesarean section, the median direct medical cost was 292 ETB (10.66 USD) while indirect costs were 591 ETB (21.60 USD). For forceps delivery, the direct medical cost was 362 ETB (13.21 USD) while the direct medical cost was 360 (13.14 USD). Distance of household from the hospital (β = 0.165), length of stay at the hospital (β = 0.050), mode of delivery (β = −0.067), and family monthly income (β = 0.201) were the explanatory variables significantly associated with the hidden cost. Conclusion: This study showed hidden cost of facility-based delivery was high. Distance, length of stay, income, and mode of delivery were the predictor of hidden cost. Ethiopian health care system should consider the hidden costs for pregnant women and their families.

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“…In 2017 the Clinton Health Access Initiative (2018) and partners announced an agreement to enable the availability of the first affordable, generic, single-pill HIV treatment containing dolutegravir (DTG) to public sector purchasers in low-income and middle-income countries to around $75 per person, per year. Somewhat differently, Pillai et al (2019) find that the mean yearly cost of pre-ART HIV care is $158.52, i.e., more specifically, $379.32, $153.36, $151.80, $143.16 for those with CD4 count <100, 101-350, 351-500, and >500 cells/mm 3 , respectively. Even $75-160 remains unaffordable for many low-income countries, even when considering the growing availability of donor funds.…”

Section: Hiv Treatment Costs and Randd Costs And Revenuesmentioning

confidence: 85%

Game theoretic analysis of persons, the pharmaceutical industry, and donors in disease contraction and recovery

Hausken

Ncube²

2020

Humanit Soc Sci Commun

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Disease contraction and recovery depend on complex interaction between persons potentially contracting and recovering from the disease, the pharmaceutical industry potentially developing drugs, and donors potentially subsidizing drug development and drug purchases. Instead of analyzing each of these three kinds of players separately, assuming the behavior of the other two kinds of players to be given, this article analyzes the three kinds of players holistically and how they mutually interact and react to each other. A five-period game between N persons and a pharmaceutical company is developed. Each person chooses safe or risky behavior, and whether or not to buy a drug. The objectives are to determine which strategies the N persons and the pharmaceutical company choose depending on the model parameters. The pharmaceutical company develops the drug if sufficiently many persons contract the disease and buy the drug. A donor chooses parametrically whether to subsidize drug development and drug purchases. Nature chooses probabilistically disease contraction, and recovery versus death with and without applying the drug. The methodological procedure is to solve the game with backward induction specifying the conditions for each of five outcomes ranging from safe behavior to risky behavior and buying the drug. The results in the form of five outcomes for a person are safe behavior, risky behavior and no disease contraction, disease contraction without drug availability, disease contraction with drug availability but without buying the drug, and disease contraction and buying the drug. These five outcomes are spread across two outcomes for the pharmaceutical company which are not to develop versus to develop the drug. The utility for the donor is specified for these two outcomes. A procedure for estimating the parameters is presented based on HIV/AIDS data. The results are discussed in terms of how various parameter combinations cause the five outcomes. An example illustrates the players’ strategic choices.

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Patient costs incurred by people living with HIV/AIDS prior to ART initiation in primary healthcare facilities in Gauteng, South Africa

Cited by 12 publications

References 25 publications

Time-critical conditions: assessment of burden and access to care using verbal autopsy in Agincourt, South Africa

Time-critical conditions: assessment of burden and access to care using verbal autopsy in Agincourt, South Africa

Hidden Costs of Hospital-Based Delivery Among Women Using Public Hospitals in Bale Zone, Southeast Ethiopia

Game theoretic analysis of persons, the pharmaceutical industry, and donors in disease contraction and recovery

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