Catastrophic healthcare expenditures and working difficulties with HIV

in low-resource settings: the Cameroonian experience

Jean-Paul Moatti1,2,3, Sandrine Loubiere1,2,3, Sylvie Boyer1,2,3, Fabienne Marcellin1,2,3, Séverin-Cécile Abega4, Maria Patrizia Carrieri1,2,3 and Bruno Spire1,2,3

Results from the EVAL survey(ANRS 12-116)

1INSERM, U912 (SE4S), Marseille, France 2Université Aix Marseille, IRD, UMR-S912, Marseille, France 3ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d’Azur, Marseille, France4Socio-anthropological Research Institute (IRSA) - Catholic University of Central African States, Yaoundé, Cameroon

ART-treated pts(n=2,206)

Not treated pts(n=674)

P-value

DIRECT COSTS

Total monthly healthcare expenditures - mean 95%CI (F CFA)

7,680[6,891-8,468]

12,083[9,846-14,320]

<.0001

Catastrophic HIV expenditures 24.8% 32.2% <.0001

INDIRECT COSTS

Working status-Employed at the time of the survey 55.8% 49.1% .003

For active participants (n=1,565)-Unable to work at least one day during the last 6 months

15.0% 21.0% .008

HIV care expenditures and indirect costs of HIV

among PLWHA in Cameroon

In a multivariate analysis,

catastrophic HIV expenditures were associated with:

• Among both ART-treated and not treated patients:

hospitalization, visit to a doctor outside the hospital,

living at >1 hour from the hospital

• Among ART-treated patients:

younger age, matrimonial status (unmarried), unemployment, no. of self-reported symptoms, follow-up in a major hospital

• Among not treated patients:

low educational level, low CD4 count, follow-up

in a central or provincial hospital

CONCLUSIONS

• High direct & indirect costs of HIV disease

• Lower healthcare expenditures in patients who get access to ART

• Inequities in access to high-quality care

• Need for a successful implementation of a free healthcare policy in resource-limited settings