Financial burden of HIV and TB among patients in Ethiopia: a cross-sectional survey

Lelisa Fekadu Assebe · Eyerusalem K. Negussie · Abdulrahman Jbaily · Mieraf Taddesse Tolla · Kjell Arne Johansson

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Healthcare Systems and Reforms Poverty, Education, and Child Welfare HIV/AIDS Impact and Responses

Abstract

OBJECTIVES: HIV and tuberculosis (TB) are major global health threats and can result in household financial hardships. Here, we aim to estimate the household economic burden and the incidence of catastrophic health expenditures (CHE) incurred by HIV and TB care across income quintiles in Ethiopia. DESIGN: A cross-sectional survey. SETTING: 27 health facilities in Afar and Oromia regions for TB, and nationwide household survey for HIV. PARTICIPANTS: A total of 1006 and 787 individuals seeking HIV and TB care were enrolled, respectively. OUTCOME MEASURES: The economic burden (ie, direct and indirect cost) of HIV and TB care was estimated. In addition, the CHE incidence and intensity were determined using direct costs exceeding 10% of the household income threshold. RESULTS: The mean (SD) age of HIV and TB patient was 40 (10), and 30 (14) years, respectively. The mean (SD) patient cost of HIV was $78 ($170) per year and $115 ($118) per TB episode. Out of the total cost, the direct cost of HIV and TB constituted 69% and 46%, respectively. The mean (SD) indirect cost was $24 ($66) per year for HIV and $63 ($83) per TB episode. The incidence of CHE for HIV was 20%; ranges from 43% in the poorest to 4% in the richest income quintile (p<0.001). Similarly, for TB, the CHE incidence was 40% and ranged between 58% and 20% among the poorest and richest income quintiles, respectively (p<0.001). This figure was higher for drug-resistant TB (62%). CONCLUSIONS: HIV and TB are causes of substantial economic burden and CHE, inequitably, affecting those in the poorest income quintile. Broadening the health policies to encompass interventions that reduce the high cost of HIV and TB care, particularly for the poor, is urgently needed.

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2003Household catastrophic health expenditure: a multicountry analysis 2007Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation 2003Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998 2007Analyzing Health Equity Using Household Survey Data 2004THE ECONOMIC BURDEN OF ILLNESS FOR HOUSEHOLDS IN DEVELOPING COUNTRIES: A REVIEW OF STUDIES FOCUSING ON MALARIA, TUBERCULOSIS, AND HUMAN IMMUNODEFICIENCY VIRUS/ACQUIRED IMMUNODEFICIENCY SYNDROME 2014Financial burden for tuberculosis patients in low- and middle-income countries: a systematic review 2016Conindex: Estimation of Concentration Indices 2008Analyzing Health Equity Using Household Survey Data

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