Marseille 2007
Marseille 2007
Abstract book
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Abstract #246  -  Economic Burden of ART Treatment for Patients in Resource-poor Settings: A Comparative Analysis of Minimalist and Holistic Healthcare Systems in Uganda
Session:
  11.2: Cost (Parallel) on Monday @ 11.00-12.30 in HC Chaired by Eileen Stillwaggon, Didier Fassin
Authors:
  Presenting Author:   Mr Achilles Ssewaya - Makerere University, Uganda
 
  Additional Authors:   
Aim:
Recent AIDS research has tended to focus on the factors influencing adherence to antiretroviral therapy (ART) in resource-poor setting leaving out the role of costs and sacrifices associated with adherence to ART. The two decades of AIDS epidemic in Resource-poor Settings, prior to the introduction of ART treatment drained household assets. More so, accessing ART treatment is associated with direct and indirect health expenditure. Direct costs refer to household expenditure linked to seeking treatment including non-medical expenses such as transport and foods; while the indirect costs refer to loss of household productive time and income loss. The assumption that guided this research is that routine ART treatment is likely to be associated with costs and adverse coping strategies which may interfere with adherence levels and treatment sustainability at the household level.
 
Method / Issue:
This is a comparative study that intended to compare the economic burden of accessing ART between a rural based Public Hospital (Kayunga) that provides only ART services and a Faith-based facility in an urban setting that provides comprehensive healthcare services. Iterative qualitative and quantitative research methods were used to implement the study, combing both cross-sectional and longitudinal study designs.
 
Results / Comments:
Preliminary results indicate that HIV patients in both healthcare systems hardly incur medical costs because ARVs and the laboratory tests are entirely free of charge in Uganda. However, HIV patients incur non-medical costs form of transport, snack expenses, and productive time and income. As expected, the holistic healthcare services provided in Faith-based facility mitigate the non-medical costs and patients tend to engage in limited range of coping strategies. To the contrary, public facility patients incur a higher cost burden leading to occasional missing of refill appointment, resorting to punitive coping strategies as well as seeking socio-economic support from socio-networks. Surprisingly, the level of treatment costs does not seem to exert significant negative effect on adherence to ART in both healthcare systems. In both healthcare systems patients occasionally miss taking the prescribed dose as well as missing the agreed dosing schedule. Secondly, in both healthcare arrangements a significant number of patients are extremely committed to taking ART treatment the rest of their life.
 
Discussion:
Whereas comprehensive social services mitigate the economic burden associated with adherence to ART, it is not the primary factor for adherence. Instead, the role of internal commitment to ART treatment (self-efficacy) that is linked to the role of adherence information, meaning attached to the miracle pill, and desire to prolong life in order to foster the dependants.
 
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