Background: HIV-infected adults and their households often face a large economic burden stemming from out-of-pocket health expenditures, clinic transportation costs, and lost from work or usual household activities. In Kenyan and Ugandan communities that began receiving streamlined HIV care (appointment reminders, quarterly visits with patient-centered care providing reduced waiting and overall visit duration) as part of the SEARCH test-and-treat trial, we examined changes in costs incurred by HIV-infected adults over a one year period.
Methods: Data were obtained through household surveys administered to a random sample of HIV-infected adults in 32 communities participating in the SEARCH trial (NCT01864603). In the 16 SEARCH intervention communities employing streamlined HIV care, we compared out-of-pocket costs (in US$) and time costs incurred by HIV-infected patients receiving antiretroviral therapy (ART) under standard HIV care at baseline (n=1,230) to costs incurred by a larger sample of patients receiving ART, including those with high CD4 cell counts, under streamlined HIV care one year later (n=1,589). We also examined changes in these costs separately in the three regions of Kenya and Uganda where the SEARCH trial is occurring. Comparison of means was performed using two-sided t-tests.
Results: Patients receiving ART under streamlined care spent less than half the time seeking and receiving healthcare than adults receiving ART under standard care (4.40 hours per month at baseline vs. 1.78 hours per month at follow-up, p< 0.001). Time spent away from employment or usual activities was also significantly reduced, from 13.0 hours per month at baseline to 8.17 hours at follow-up (p< 0.01). The reductions in time costs were largest in SEARCH intervention communities in Uganda compared to Kenya. Out-of-pocket healthcare and transportation costs incurred by patients did not differ significantly between baseline and one year later ($2.98 and $2.46 in past month at baseline and one year, respectively).
Conclusions: Following the introduction of streamlined care for HIV-infected individuals, there was a significant reduction in time spent seeking healthcare and being away from employment and other usual activities. Streamlined care provision may partially reduce the economic burden faced by individuals receiving HIV care and contribute to improvements in patients'' employment outcomes and economic well-being.