Assessment of out-of-pocket and catastrophic expenses incurred by patients with Human Immunodeficiency Virus (HIV) in availing free antiretroviral therapy services in India

• Published in: Public health (London) 2020-06, Vol.183, p.16-22
• Main Authors: Alvi, Y., Faizi, N., Khalique, N., Ahmad, A.
• Format: Article
• Language: English
• Subjects: Access; Adolescent; Adult; Anti-Retroviral Agents - economics; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Catastrophic; Catastrophic Illness - economics; CD4 antigen; Confidence intervals; Costs; Cross-Sectional Studies; Demographic variables; Demography; Dependent variables; Drug therapy; Expenditures; Female; Health care expenditures; Health Expenditures - statistics & numerical data; Health outcomes; Health services; Health services utilization; Help seeking behavior; HIV; HIV Infections - drug therapy; HIV Infections - economics; HIV/AIDS; Households; Human immunodeficiency virus; Humans; Immune response; Independent variables; India; Integrated care; Male; Middle Aged; OOP; Patients; Personal expenditure; Regression analysis; Socioeconomic factors; Socioeconomics; Statistical analysis; Therapy; UHC; Unemployed people; Universal Health Insurance; Viruses; Young Adult
• ISSN: 0033-3506; 1476-5616
• DOI: 10.1016/j.puhe.2020.03.031

With the free availability of antiretroviral therapy in India, one expects that the out-of-pocket (OOP) expenditure would reduce and would not be a significant financial burden. However, the cost of seeking care is also dependent on accessibility of services, as well as other non-medical and indirect expenses. This study aims to analyze the OOP expenditure in availing antiretroviral therapy (ART) services and determine the prevalence and pattern of catastrophic and impoverishing health expenditure. The study also discusses the policy implications of these findings in the light of growing commitment toward universal health coverage. This was a cross-sectional study. A total of 434 patients receiving antiretroviral treatment were interviewed. OOP expenses included a measure of direct medical expenditure, non-medical expenditure, and indirect expenditure incurred in availing ART services. A threshold level of 40% of ‘capacity to pay’ was taken as catastrophic expenditure. Based on previous research, different demographic, socio-economic, and clinical factors were selected as independent variables to determine their association with catastrophic expenditure. Logistic regression was conducted to study the association between independent and dependent variables keeping the level of significance at