The cost of accessing infant HIV medications and health services in Uganda

Abstract

Patient costs are a critical barrier to the elimination of mother to child HIV transmission. Despite the Ugandan government providing free public HIV services, infant antiretroviral (ARV) prophylaxis coverage remains low (25%). To understand costs mothers incur in accessing ARV prophylaxis for their infants, we conducted a mixed methods study to quantify and identify their direct costs. We used cross-sectional survey data and focus group discussions from 49 HIV-positive mothers in Uganda. Means and standard deviations were calculated for the direct costs (e.g., transportation, caretaker, services/medications) involved in accessing infant HIV services. The direct cost of attending HIV clinic visits averaged $3.71 (SD = $3.52). Focus group discussions identified two costs hindering access to infant HIV services: transportation costs and informal service charges. All participants reported significant costs associated with accessing infant HIV services - the equivalent of 2-3 days' income. To address transportation costs, community and home care models should be explored. Additionally, stricter policies and oversight should be implemented to prevent informal HIV service charges.

Community-funded integrated care outreach clinics as a capacity building strategy to expand access to health care in remote areas of Uganda

“…Decreased proximity to urban centers leads to global inequities in health, education, and economic opportunities [ 1 ]. In Sub-Saharan Africa, transportation barriers limit care-seeking behavior and reduce access to HIV services, malaria treatment, and emergency obstetrical interventions [ 2–4 ] while long distance to the nearest health facility is a determinant of rural child mortality [ 5 ]. Round-trip transportation to a local health facility can be cost-prohibitive in settings with high poverty, and the resulting underutilization of health services is a critical global health issue [ 6 , 7 ].…”

Costs of accessing HIV testing services among rural Malawi communities

“…Other studies in the region have explored determinants of testing (Camlin et al., 2016 ; Helleringer, Kohler, Frimpong, & Mkandawire, 2009 ; Lépine, Terris-Prestholt, & Vickerman, 2014 ), costs of providing HIV services (Maheswaran et al., 2016 ; Mangenah, Mwenge, et al., 2017 ; Mwenge et al., 2017 ; Sharma et al., 2015 ), and costs of accessing tuberculosis (TB) treatment (Kemp, Mann, Simwaka, Salaniponi, & Squire, 2007 ) and ART (Bergmann, Wanyenze, & Stockman, 2017 ; Chimbindi et al., 2015 ; Pinto et al., 2013 ; Rosen, Ketlhapile, Sanne, & DeSilva, 2007 ). The few that have explored costs associated with HIV testing have either focused on urban settings (Maheswaran et al., 2016 ) or examined costs without considering lost income (Bergmann et al., 2017 ). The results of this study will inform the design of future HIV testing services and interventions aimed at overcoming financial barriers to testing.…”

The integration of the global HIV/AIDS response into universal health coverage: desirable, perhaps possible, but far from easy

“…In Kenya, the costs of frequent travels towards hospitals or health centres and registration fees exclude the poorest people from ART [21]. In Uganda as well, transportation costs seem to create a key financial barrier [22]. In Ukraine, we did not find evidence of financial barriers at the individual level [23].…”

“…Usually, the allocation of free insurance cards is left to local authorities and communities, based on assessment of household income [82]. However, considering that even now (when and where ART is provided for free) transportation costs exclude the poorest people [21, 22], a general waiver for all people needing chronic care, decided by healthcare providers, should be considered.…”