Patient costs for prevention of mother-to-child HIV transmission and antiretroviral therapy services in public health facilities in Zimbabwe

• Published in: PloS one 2021-08, Vol.16 (8), p.e0256291-e0256291
• Main Authors: Chingombe, Innocent, Mapingure, Munyaradzi P, Balachandra, Shirish, Chipango, Tendayi N, Gambanga, Fiona, Mushavi, Angela, Apollo, Tsitsi, Suraratdecha, Chutima, Rogers, John H, Ruangtragool, Leala, Gonese, Elizabeth, Musuka, Godfrey N, Mugurungi, Owen M, Harris, Tiffany G
• Format: Article
• Language: English
• Subjects: Adult; Adults; Anti-HIV Agents - economics; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; Biology and Life Sciences; Child care; Consent; Cost estimates; Cost of Illness; Cost-Benefit Analysis - statistics & numerical data; Costs; Cross-Sectional Studies; Data collection; Disease control; Disease prevention; Disease transmission; Drug therapy; Evaluation; Female; Funding; Health Care Costs - statistics & numerical data; Health care facilities; Health Expenditures - statistics & numerical data; Health facilities; HIV; HIV infection; HIV Infections - drug therapy; HIV Infections - economics; HIV Infections - transmission; HIV Infections - virology; Human immunodeficiency virus; Humans; Infectious Disease Transmission, Vertical - economics; Infectious Disease Transmission, Vertical - prevention & control; Mean; Medical care, Cost of; Medicine and Health Sciences; Onsite; Patients; People and Places; Pregnancy; Prenatal Care - economics; Prevention; Public health; Questionnaires; Social Sciences; Travel time; Womens health; Zimbabwe
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0256291

Zimbabwe has made large strides in addressing HIV. To ensure a continued robust response, a clear understanding of costs associated with its HIV program is critical. We conducted a cross-sectional evaluation in 2017 to estimate the annual average patient cost for accessing Prevention of Mother-To-Child Transmission (PMTCT) services (through antenatal care) and Antiretroviral Treatment (ART) services in Zimbabwe. Twenty sites representing different types of public health facilities in Zimbabwe were included. Data on patient costs were collected through in-person interviews with 414 ART and 424 PMTCT adult patients and through telephone interviews with 38 ART and 47 PMTCT adult patients who had missed their last appointment. The mean and median annual patient costs were examined overall and by service type for all participants and for those who paid any cost. Potential patient costs related to time lost were calculated by multiplying the total time to access services (travel time, waiting time, and clinic visit duration) by potential earnings (US$75 per month assuming 8 hours per day and 5 days per week). Mean annual patient costs for accessing services for the participants was US$20.00 [standard deviation (SD) = US$80.42, median = US$6.00, range = US$0.00-US$12,18.00] for PMTCT and US$18.73 (SD = US$58.54, median = US$8.00, range = US$0.00-US$ 908.00) for ART patients. The mean annual direct medical costs for PMTCT and ART were US$9.78 (SD = US$78.58, median = US$0.00, range = US$0.00-US$ 90) and US$7.49 (SD = US$60.00, median = US$0.00) while mean annual direct non-medical cost for US$10.23 (SD = US$17.35, median = US$4.00) and US$11.23 (SD = US$25.22, median = US$6.00, range = US$0.00-US$ 360.00). The PMTCT and ART costs per visit based on time lost were US$3.53 (US$1.13 to US$8.69) and US$3.43 (US$1.14 to US$8.53), respectively. The mean annual patient costs per person for PMTCT and ART in this evaluation will impact household income since PMTCT and ART services in Zimbabwe are supposed to be free.