145 lines
4.8 KiB
YAML
145 lines
4.8 KiB
YAML
abstract: 'Introduction Placing all clients with a positive diagnosis for HIV on
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antiretroviral therapy (ART) has cost implications both for patients and
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health systems, which could, in turn, affect feasibility, sustainability
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and uptake of new services. Patient-incurred costs are recognized
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barriers to healthcare access. Differentiated service delivery (DSD)
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models in general and community-based care in particular, could reduce
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these costs. We aimed to assess patient-incurred costs of a
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community-based DSD intervention (clubs) compared to clinic-based care
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in the Shinyanga region, Tanzania. Methods Cross-sectional survey among
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stable ART patients (n = 390, clinic-based; n = 251, club-based). For
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each group, we collected socio-demographic, income and expenditure data
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between May and August 2019. We estimated direct and indirect
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patient-incurred costs. Direct costs included out-of-pocket
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expenditures. Indirect costs included income loss due to time spent
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during transport, accessing services and off work during illness. Cost
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drivers were assessed in multivariate regression models. Results
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Overall, costs were significantly higher among clinic participants.
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Costs (USD) per year for clinic versus club were as follows: 11.7 versus
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4.17 (p < 0.001) for direct costs, 20.9 versus 8.23 (p < 0.001) for
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indirect costs and 32.2 versus 12.4 (p < 0.001) for total costs. Time
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spent accessing care and time spent in illness (hours/year) were 38.3
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versus 13.8 (p < 0.001) and 16.0 versus 6.69 (p < 0.001) respectively.
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The main cost drivers included transportation (clinic vs. club: 67.7\%
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vs. 44.1\%) for direct costs and income loss due to time spent accessing
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care (clinic vs. club: 60.4\% vs. 56.7\%) for indirect costs. Factors
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associated with higher total costs among patients attending clinic
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services were higher education level (coefficient {[}95\% confidence
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interval]) 20.9 {[}5.47 to 36.3]) and formal employment (44.2 {[}20.0 to
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68.5). Differences in mean total costs remained significantly higher
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with formal employment, rural residence, in addition to more frequent
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visits among clinic participants. The percentage of households
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classified as having had catastrophic expenditures in the last year was
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low but significantly higher among clinic participants (10.8\% vs.
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5.18\%, p = 0.014). Conclusions Costs incurred by patients accessing DSD
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in the community are significantly lower compared to those accessing
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standard clinic-based care. DSD models could improve access, especially
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in resource-limited settings.'
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affiliation: 'Okere, NE (Corresponding Author), Amsterdam Inst Global Hlth \& Dev,
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AHTC Tower C4 Paasheuvelweg 25, NL-1105 BP Amsterdam, Netherlands.
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Okere, Nwanneka E., Sanofi Pasteur, Vaccine Epidemiol \& Modelling Dept, Lyon, France.
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Okere, Nwanneka E.; Corball, Lucia; Hermans, Sabine; de Wit, Tobias F. Rinke, Univ
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Amsterdam, Amsterdam UMC, Amsterdam Inst Global Hlth \& Dev, Dept Global Hlth, Amsterdam,
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Netherlands.
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Kereto, Dunia, Bugisi Hlth Ctr, Shinyanga, Tanzania.
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Naniche, Denise, Univ Barcelona, Hosp Clin, ISGLOBAL Barcelona Inst Global Hlth,
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Barcelona, Spain.
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Gomez, Gabriela B., London Sch Hyg \& Trop Med, Dept Global Hlth \& Dev, London,
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England.'
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article-number: e25760
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author: Okere, Nwanneka E. and Corball, Lucia and Kereto, Dunia and Hermans, Sabine
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and Naniche, Denise and de Wit, Tobias F. Rinke and Gomez, Gabriela B.
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author-email: n.okere@aighd.org
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author_list:
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- family: Okere
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given: Nwanneka E.
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- family: Corball
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given: Lucia
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- family: Kereto
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given: Dunia
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- family: Hermans
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given: Sabine
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- family: Naniche
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given: Denise
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- family: de Wit
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given: Tobias F. Rinke
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- family: Gomez
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given: Gabriela B.
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da: '2023-09-28'
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doi: 10.1002/jia2.25760
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eissn: 1758-2652
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files: []
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journal: JOURNAL OF THE INTERNATIONAL AIDS SOCIETY
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keywords: 'costs; antiretroviral treatment; differentiated service delivery;
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Tanzania; catastrophic costs; patient-incurred costs'
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keywords-plus: 'ANTIRETROVIRAL THERAPY; HEALTH FACILITIES; HIV TREATMENT; MODEL;
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DECENTRALIZATION; RETENTION; MALAWI; INCOME'
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language: English
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month: JUN
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number: '6'
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number-of-cited-references: '50'
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orcid-numbers: 'Gomez, Gabriela B/0000-0002-7409-798X
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Naniche, Denise S/0000-0002-4495-6325
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Okere, Nwanneka/0000-0001-9182-6518'
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papis_id: 3f7a32a6e71b141939e870c7fc38ace3
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ref: Okere2021patientincurredcosts
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researcherid-numbers: 'Gomez, Gabriela B/HSB-1504-2023
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Naniche, Denise S/S-1814-2018
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'
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times-cited: '0'
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title: Patient-incurred costs in a differentiated service delivery club intervention
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compared to standard clinical care in Northwest Tanzania
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type: article
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unique-id: WOS:000667805400005
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usage-count-last-180-days: '0'
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usage-count-since-2013: '1'
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volume: '24'
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web-of-science-categories: Immunology; Infectious Diseases
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year: '2021'
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