HIV This Week

Moon S, Van Leemput L, Durier N, Jambert E, Dahmane A, Jie Y, Wu G, Philips M, Hu Y, Saranchuk P. Out-of-pocket costs of AIDS care in China: are free antiretroviral drugs enough? AIDS Care. 2008;20(8):984-94.

Financial access to HIV care and treatment can be difficult for many people in China, where the government provides free antiretroviral drugs but does not cover the cost of other medically necessary components, such as lab tests and drugs for opportunistic infections. This article estimates out-of-pocket costs for treatment and care that a person living with HIV in China might face over the course of one year. Data comes from two treatment projects run by Médecins Sans Frontières in Nanning, Guangxi Province and Xiangfan, Hubei Province. Based on the national treatment guidelines, Moon and colleagues estimated costs for seven different patient profiles ranging from WHO Clinical Stages I through IV. They found that patients face significant financial barriers to even qualify for the free antiretroviral treatment program. For those who do, HIV care and treatment can be a catastrophic health expenditure, with cumulative patient contributions ranging from approximately US$200-3939/year in Nanning and US$13-1179/year in Xiangfan, depending on the patient’s clinical stage of HIV infection. In Nanning, these expenses translate as up to 340% of an urban resident’s annual income or 1200% for rural residents; in Xiangfan, expenses rise to 116% of annual income for city dwellers and 295% in rural areas. While providing antiretroviral drugs free of charge is an important step, the costs of other components of care constitute important financial barriers that may exclude patients from accessing appropriate care. Such barriers can also lead to undesirable outcomes in the future, such as impoverishment of AIDS-affected households, higher antiretroviral drug-resistance rates and greater need for complex, expensive second-line antiretroviral drugs.

Editors’ note: Using data demonstrating that, for many people on HIV treatment in China, out-of-pocket expenditures reach ‘catastrophic’ health expenditure levels, the authors urge policy makers to consider both patient health and long-term treatment programme viability in designing strategies to prevent widespread resistance. Out-of-pocket expenditures create serious impediments for people who need antiretroviral therapy to access treatment, attend clinic regularly, and achieve high adherence levels. There are cogent economic arguments in favour of a free minimum package of HIV care that goes beyond antiretroviral drugs to include HIV tests, consultations, laboratory testing, hospitalisation, prophylaxis, and treatment of common opportunistic infections.