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Setting

Time and money: the cost of utilizing HIV and TB treatment and care in rural KwaZulu-Natal (poster #MOPDE0201). Setting

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Setting

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  1. Time and money: the cost of utilizing HIV and TB treatment and care in rural KwaZulu-Natal(poster #MOPDE0201) Setting Hlabisa HIV Treatment and Care Programme - a partnership between the Department of Health and the Africa Centre for Health and Population Studies, provides free-of-charge HIV and TB services in primary healthcare clinics in Hlabisa sub-district Methods Two cross-sectional studies - 2009 and 2010 Probability-proportional-to-size sampling 300 patients on antiretroviral treatment (ART), 200 pre-ART, 300 receiving TB treatment - exclusive groups Data on self-reported - time, financial healthcare expenditures and financial distress indicators (borrowing money and/or selling assets) due to healthcare expenditure

  2. Main findings • A third of people reported borrowing money to pay for healthcare in the past four weeks but less than 10% needed to sell assets • Financial distress was higher in TB (41%) and ART (39%) patients than pre-ART (31%) patients • 1USD is approximately equivalent to 8 South African Rands (ZAR) • Pre-ART patients spent more on other healthcare services and self-care than ART and TB patients (163 ZAR pre-ART; 117 ZAR ART; 90 ZAR TB) • Transport cost was the largest per clinic visit cost expenditure in all three groups • Every additional 10 ZAR spent on the clinic visit increased the odds of financial distress by 51% for pre-ART, 4% for ART and 9% for TB patients • Every additional 10 ZAR spent on utilizing other healthcare services increased the odds of financial distress by about 3% in all groups • Each additional hour spent at the clinic significantly increased the odds of financial distress by 21% for ART and 64% for TB patientsbut by 8% in pre-ART patients which was non-significant

  3. Conclusions • Despite HIV and TB treatment being free, most patients faced a high financial burden due to healthcare expenditures in this area with high unemployment • Higher expenditure amongst pre-ART patients utilizing other healthcare services could indicate a change in health-seeking behaviour once a patient is initiated onto treatment • A relatively small expenditure in utilizing healthcare can translate to financial distress in a poor community that relies mainly on temporary state grants of between 300-1200 ZAR [approx 36 - 144 USD] per month • Financial distress due to healthcare utilization may lead to reduced ART and TB treatment uptake, adherence and retention in care • Subsidized transport to public clinics providing free HIV and TB services may help reduce the time and financial burden

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