1 / 20

Ministère de la Santé Publique du Cameroun

FPAE CASS-RT / Un. Ydé I GRAPS / Un. Ydé II. Le programme d’évaluation de l’accès aux ARV au Cameroun Projets ANRS - Pr. Séverin-Cécile Abega, IRSA / UCAC Yaoundé Pr JeanPaul Moatti, INSERM/IRD/Université UMR 912 Marseille Dr. Fred Eboko, IRD UR002 Marseille / FPAE Yaoundé -.

chinara
Télécharger la présentation

Ministère de la Santé Publique du Cameroun

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. FPAE CASS-RT / Un. Ydé I GRAPS / Un. Ydé II Le programme d’évaluation de l’accès aux ARV au CamerounProjets ANRS- Pr. Séverin-Cécile Abega, IRSA / UCAC Yaoundé Pr JeanPaul Moatti, INSERM/IRD/Université UMR 912 Marseille Dr. Fred Eboko, IRD UR002 Marseille / FPAE Yaoundé - Ministère de la Santé Publique du Cameroun

  2. Un enjeu de santé publique, une réponse scientifique • Le contexte • Des baisses successives des prix des ARV au Cameroun • Une politique de décentralisation inédite • Un enjeu national et international • Un objectif • Évaluer un processus en cours et proposer des connaissances objectives • 4 projets de recherche ANRS concernant ce programme concerté d’évaluation sont déjà en cours - STRATALL - EVAL - POLART - Passage à l’échelle

  3. STRATALL ANRS 12 110Pr. Delaporte (IRD Montpellier), Dr Kouanfack (HCY Ydé) Volet sciences sociales : Pr. Moatti (INSERM), Pr. Abega (UCAC) « Décentralisation de l’accès antirétroviral en Afrique : Évaluation de la prise en charge des patients sous ARV dans des hôpitaux de district selon une approche de suivi allégé » • Objectifs du volet sciences sociales • Évaluation de la stratégie «allégée» du point de vue : - de la qualité de vie - de l’observance - de la faisabilité socio-économique

  4. « Impact du programme camerounais d’accès aux ARV sur la prise en charge et les conditions de vie de la population infectée par le VIH » Évaluation de l’impact de l’accès au traitement ARV sur les conditions de vie des PVVS Observance et efficacité médicale Qualité de vie Equité dans l’accès aux ARV Comportements à risque Évaluation de l’impact sur le système de santé et notamment sur les connaissances, attitudes, croyances et pratiques des PS Changements introduits dans l’organisation des soins Impact sur les connaissances et pratiques médicales EVAL ANRS 12 116 Pr. Moatti (Inserm Marseille), Pr. Abega (UCAC Yaoundé)

  5. EVAL, une enquête en 3 phases comportant: Un volet quantitatif : Enquête transversale auprès d’un échantillon aléatoire de 3151 adultes VIH+ interrogés dans 27 CTA/UPEC (taux de réponse= 82%) Enquête transversale auprès d’un échantillon de 317personnels soignants des 27 mêmes CTA/UPEC Recueil de données sur l’offre de soins Un volet qualitatif Entretiens auprès de patients Entretiens auprès de soignants EVAL ANRS 12 116 Pr. Moatti (Inserm Marseille), Pr. Abega (UCAC Yaoundé)

  6. POLART ANRS 12 120Dr F. Eboko (IRD/FPAE), Pr. Sindjoun (GRAPS, Un. Ydé 2) « La problématique de l'accès aux médicaments contre le sida au Cameroun. Enjeux, avancées, limites et perspectives de la décentralisation d’une offre de soins » • Objectifs : • Identifier les acteurs de la décentralisation des ARV et de la prise en charge • Analyser leurs rôles et la configuration qu’ils présentent • Analyser l’effet de l’implication des partenaires extérieurs dans le processus de décentralisation • Appréhender les facteurs qualitatifs qui différencient la PEC d’un site à l’autre

  7. Financial difficulties in accessing HIV care in Yaounde, Cameroon:first results from the national cross-sectional survey EVAL-ANRS 12-116 Sylvie Boyer1,2, F.Marcellin1,2, P.O. Zogo3, S.C. Abega4, R. Nantchouang4, B. Spire1,2, J.P. Moatti1,2 1 Health and Medical Research National Institute (INSERM) Research Unit 379, Marseilles, France 2 South Eastern Health Regional Observatory (ORS-PACA), Marseilles, France 3 Public Health Ministry - Operational Research Department, Yaoundé, Cameroon 4 Socio-anthropological Research Institute (IRSA) - Catholic University of Central African States, Yaoundé, Cameroon Aids Impact Conference, session 19: Universal Access to care

  8. Study objectives • to study the extent to which user fees created financial barriers for access to effective ART among ART-treated patients in Cameroon in 2006 • by describing health expenditures of ART-treated patients • by analyzing factors associated with financial difficulties in purchasing ART

  9. The EVAL survey (ANRS 12-116) • national, cross-sectional • 27 HIV treatment centers in Cameroon • between September 2006 and March 2007 • random sample of 3000 PLWHA • aged ³ 21 years • diagnosed HIVÅ for ³ 3 months • first phase of the survey (n=707 PLWHA) conducted in Yaoundé hospitals and its neighborhood

  10. Quantitative data collected • patient questionnaire (anonymous, face-to-face) • 147 questions including especially: • - socio-demographic and economic aspects • monthly household income • - disease history, treatments and medical follow-up • - adherence to ART • dose taking during the prior 4 days • respect of time schedule and treatment interruption • - health care consumption and expenditures • detailed health expenditures of the previous month • difficulties paying for ART drugs and biological tests • medical questionnaire • blood sample for CD4 count assessment

  11. First phase of the survey (Sept.-Oct.2006) • 6 HIV treatment centers in Yaoundé and its neighborhood • 843 eligible PLWHA randomly selected • 707 participants (84%) including: • - 532 (75%) ART-treated patients (study sample) • - 83 (12%) waiting for biological results before starting ART • - 78 (11%) never treated and not in process of initiating ART • - 15 (2%) having stopped ART for medical reasons

  12. Healthcare expenditure • total healthcare expenditure in the previous month • median [IQR] ´106 FCFA 9.8 [6.3; 18.6] • % of monthly household income 15 [7; 34] • catastrophic health expenditure for 40% of patients • distribution between the main items of health expenditure (median) • - ART drugs 47% • - transport to hospital 12% • - consulting fees 6% • assistance received • - financial help outside of household or loan 40% • - regular financial help to purchase ART 42.5% • - free ART 4.5%

  13. Financial difficulties in access to care • « During the last 12 months, • did you have difficulties in paying for your lab • tests for the follow-up of your illness? » • yes 440 (83%) • no 267 (17%) • « During the last three months, • has it ever happened that you couldn’t buy • your ART drugs because of a lack of money? » • yes, at least once 107 (20%) • no never 425 (80%)

  14. Univariate models • Not significantly associated with financial difficulties (p>0.05) • gender • educational level * • living in a stable relationship • no. of children in the household • no. of adults in the household • previous month’s health expenditures • CD4 at initiation of ART • history of AIDS-defining events • no. of hospitalizations during the previous 6 months * • time since ART initiation * • * eligible for multivariate analysis (p<0.25)

  15. Variables Financial difficulties OR [95%CI] With Without 1. Sociodemographic and economic characteristics age- mean( SD)- years, OR for 10 years 36 (8) 39 (9) 0.7 [0.5; 0.9] son/daughter of the head of household 10.3% 17.4% 0.5 [0.3; 1.1] monthly household incomeX 10.6 FCFA median [IQR] 20 [0; 45] 20 [0; 80] 0.3 [0.2;0.6] Previous month health expenditures as % of monthly household income median [IQR] 19% [8; 47] 13%[6; 33] 1.6 [1.1; 2.3] 2. Clinical and HIV-related characteristics CD4 count at the time of survey<200 85% 84% 1.8 [1.1; 2.8] high adherence to ART 30% 63% 0.2 [0.1; 0.4] Univariate models

  16. Variables OR [95%CI] p-value age- OR for 10 years 0.6 [0.5; 0.8] 0.001 son/daughter of the head of household 0.4 [0.2; 0.7] 0.006 monthly household income 0.3 [0.2; 0.6] <0.0001 Multivariate models

  17. Financial difficulties, adherence and CD4 count • Patients with financial difficulties • are less likely to be adherent to ART • adjusted OR [95% CI] 0.2 [0.1; 0.4] (p<0.0001) • are more likely to have CD4 count < 200 cells/µl • after 6 months of ART • adjusted OR [95% CI] 2.1 [1.1; 3.9] (p=0.02)

  18. Conclusions ... • user fees remain a major barrier to the delivery of appropriate ART • age, household income and relationship with the head of household are predictors of financial difficulties in purchasing ART • patients having financial difficulties are less likely to be adherent to ART and more likely to be immunodepressed • extension of the results to the rest of the country • analysis of the impact of user fees on access to ART for patients not being treated at the time of survey ... perspectives …

  19. And health financing policy implications • review of the user fees system • - free ART since May 2007 in Cameroon • but ... • 26% of patients in our sample will still encounter • catastrophic health expenditures • - free care for PLWHA • development of public financing and new forms • of financing procedures • - Senegal experience

  20. Acknowledgements • PLWHAswhoparticipated in the study • Public HealthMinistry of Cameroon • French national agency for research on AIDS and viral hepatitis B and C (ANRS) • The EVAL team • Healthcareprofessionals in the 27 hospitals

More Related