Missing the Target #5: Improving AIDS Drug Access ... - CD8 T cells

The real cost of free treatmentBy anonymous Missing the Target teamChina announced a “free” AIDS treatment program in late 2003, but in fact thereare a number of ART-related costs that must be borne by patients. The only part ofthe treatment that is truly “free” is the ARVs themselves. Diagnostic tests, treatmentsfor OIs, and most other related costs often must be paid by patients themselves.Substantial discrepancies in service delivery exist from province to province, andeven among different cities in the same province, because each distinct area hasflexibility (and the burden) to manage its own treatment program. Based on anumber of sources around China, costs that generally must be paid by patientsinclude:• Western blot confirmation test ($50 to $80 for an individual test);• CD4 tests (usually required twice a year, with costs ranging from $10 to$25 each time);• regular diagnostic tests (required a minimum of twice a year, such testsinclude blood count, liver function, and other tests; costs about $30 a year);• viral load tests, when available (about $150); and• OI treatment (cost and frequency varies greatly, with an approximaterange of $150 to $4,200 per year).It is important to acknowledge that some cities and provinces have eliminated someof these charges for PLWHA. For example, the city of Guangzhou has allocatedapproximately 7,000 yuan ($940) a year per person to cover inpatient costs;Guangxi province recently stopped charging for the Western blot confirmationand initial CD4 tests; and many areas have significantly reduced the price of CD4tests. However, there is no uniform national policy, and the cost of OI treatmentsis generally prohibitively high. In many areas, hospitals are under heavy financialpressure to produce revenue, and as a result they seek to earn high profits fromboth tests and OI treatments for PLWHA.In a study carried out by Médecins Sans Frontières (MSF) based on its own clinicexperience in Guangxi and Hubei provinces, the actual amount that each patienthad to spend on OI treatments ranged from about $45 to more than $8,000annually, with a mean of $928 (“Cost of Care”, MSF, August 2006). While this datais from only two sites, PLWHA in other provinces report spending similar amountson OI treatments, diagnostic tests and follow-up, transportation to and from13