Marseille 2007
Marseille 2007
Abstract book
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Abstract #392  -  Financial difficulties in accessing HIV care in Yaounde, Cameroon: first results from the national cross-sectional survey EVAL-ANRS 12-116
Session:
  19.3: Universal Access to care (Parallel) on Monday @ 14.00-16.00 in HC Chaired by Shirin Heidari, Jean-Paul Moatti
Authors:
  Presenting Author:   Ms Sylvie Boyer - Health and Medical Research National Institute (INSERM), France
 
  Additional Authors:  Mrs Fabienne Marcellin, Dr Pierre Ongolo-Zogo, Prof Sverin-Ccile Abega, Prof Robert Nantchouang, Dr Bruno Spire, Prof Jean-Paul Moatti,  
Aim:
Over the last six years the Cameroonian government has developed an ambitious program for access to antiretroviral treatment (ART) for people living with HIV/AIDS (PLWHA), characterised by a strong subsidizing of health care costs for patients. At the end of 2006, monthly ART prices were as follows: 3,000 CFA for triomune and 7,000 CFA for other regimens. Under some conditions, ART could also be delivered free of charge for very poor patients. Prophylactic treatment of opportunistic infections with cotrimoxazol was free and the six-monthly biological check-up for patients was fixed at 3,000 CFA. This paper aims at analysing the health expenditures of PLWHA in Cameroon and its relation to access to care.
 
Method / Issue:
EVAL (ANRS12-116) is a national cross-sectional multicenter survey conducted in Cameroon among PLWHA, with the support of the French National Agency for Research on AIDS and hepatitis (ANRS). Eligibility criteria include being over 21 years old and having been diagnosed HIV/AIDS positive for at least three months. Socio-demographic, economic and psychosocial data, including treatment history and access to HIV care, are collected using face-to-face questionnaires. Clinical data are collected using medical questionnaires. We present data collected among the first 707 patients included in 6 treatment centers in Yaound and its neighbourhood.
 
Results / Comments:
Seventy-one percent of these patients (n=500) are women; mean age (SD) is 38(9) years old and mean of household monthly income is 98,000 (81,000) CFA. Three quarters of patients (n=532) are receiving ART. Among the remaining 175 patients, 82 (47%) are waiting for biological results to initiate ART and 15 (7%) have stopped ART for medical reasons. Among treated patients (n=532), 24 (4.5%) have free access to ART and 226 (42.5%) receive regular help to buy HIV treatment, mainly from their families (94%). Health expenditures of this patients are mainly related to the purchase of ART and transport charges (32.4% and 14.4% of total monthly health expenditures respectively); for non-treated patients, this one are mainly focused on biological examinations, non-ART treatments and hospitalizations (29.3%, 28.6% and 18.7% of total monthly health expenditures respectively). Mean monthly health-related expenditures represent a larger part of the household income among treated patients than among others (21.7% versus 18.5%, p<0.0001). Twenty percent of treated patients (n=107) report not having been able to buy ART on at least one occasion during the previous three months because of financial difficulties. Mean monthly health-related expenditures represent a larger part of the household income among these patients than among the others (24.5% versus 21%, p=0.047), and even exceed the household income for 26 patients, who depend on loans or receive help from their family. Eighty-three percent of patients of our sample (n=583) also report having difficulties when paying for biological examinations.
 
Discussion:
The subsidizing policy is a success as access to ART is possible for most patients in our sample and specially for women. However, according to our preliminary results, some difficulties remain in access to care. Socio-economic and financial factors associated with treatment adherence will be explored in further analysis.
 
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