The Impact of Immediate Initiation of Antiretroviral Therapy on Patients' Healthcare Expenditures: A Stepped-Wedge Randomized Trial in Eswatini.

Autor: Steinert JI; TUM School of Governance, Technical University of Munich, Munich, Germany. Janina.steinert@tum.de., Khan S; Clinton Health Acccess Initiative, Boston, USA., Mafara E; Clinton Health Acccess Initiative, Boston, USA., Wong C; Clinton Health Acccess Initiative, Boston, USA., Mlambo K; Clinton Health Acccess Initiative, Boston, USA., Hettema A; Clinton Health Acccess Initiative, Boston, USA., Walsh FJ; Clinton Health Acccess Initiative, Boston, USA., Lejeune C; Clinton Health Acccess Initiative, Boston, USA., Mazibuko S; Ministry of Health of the Kingdom of Eswatini, Mbabane, Eswatini., Okello V; Ministry of Health of the Kingdom of Eswatini, Mbabane, Eswatini., Ogbuoji O; Duke Global Health Institute, Duke University, Durham, USA., De Neve JW; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany., Vollmer S; Chair of Development Economics, University of Göttingen, Göttingen, Germany., Bärnighausen T; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany., Geldsetzer P; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.; Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA.
Jazyk: angličtina
Zdroj: AIDS and behavior [AIDS Behav] 2021 Oct; Vol. 25 (10), pp. 3194-3205. Date of Electronic Publication: 2021 Apr 08.
DOI: 10.1007/s10461-021-03241-9
Abstrakt: Immediate initiation of antiretroviral therapy (ART) for all people living with HIV has important health benefits but implications for the economic aspects of patients' lives are still largely unknown. This stepped-wedge cluster-randomized controlled trial aimed to determine the causal impact of immediate ART initiation on patients' healthcare expenditures in Eswatini. Fourteen healthcare facilities were randomly assigned to transition at one of seven time points from the standard of care (ART eligibility below a CD4 count threshold) to the immediate ART for all intervention (EAAA). 2261 patients living with HIV were interviewed over the study period to capture their past-year out-of-pocket healthcare expenditures. In mixed-effects regression models, we found a 49% decrease (RR 0.51, 95% CI 0.36, 0.72, p < 0.001) in past-year total healthcare expenditures in the EAAA group compared to the standard of care, and a 98% (RR 0.02, 95% CI 0.00, 0.02, p < 0.001) decrease in spending on private and traditional healthcare. Despite a higher frequency of HIV care visits for newly initiated ART patients, immediate ART initiation appears to have lowered patients' healthcare expenditures because they sought less care from alternative healthcare providers. This study adds an important economic argument to the World Health Organization's recommendation to abolish CD4-count-based eligibility thresholds for ART.
(© 2021. The Author(s).)
Databáze: MEDLINE
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