MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Total health expenditures for HIV care and catastrophic health expenditures
In the study sample, health expenditures (other than for ART treatment) equalled on average US$
11.3 per month for treated patients and US$ 18.6 per month for untreated patients.
For treated patients, these expenditures consisted primarily of transport and medication (other
than ART treatment) costs; for untreated patients, expenditures were devoted for the most part to
medication, biological exams and hospitalization.
Without considering expenditures for ART, about a quarter of treated patients and a third of
untreated patients enrolled in the study still faced catastrophic health care expenditures.
Catastrophic expenditures were logically associated with patients’ income and more frequently
affected patients who were not officially classified as “indigent” and so did not qualify for an
exemption from user fees 8 . The risk of catastrophic expenditures was also higher for those who did
not live in the same city as the follow-up hospital; who consulted a physician outside of the
hospital; or who had been hospitalized during the previous six months.
However, the risk of facing catastrophic expenditures was lower for patients followed in HIV
services of the provincial or district levels compared to those followed in the ATCs of the central
level.
Direct and indirect costs of HIV disease
Besides health expenditures, PLWHA face supplementary costs, known as "indirect costs"
connected to the loss of professional activity and thus resources. These costs were greater for
untreated patients than for treated patients, as treated patients are more likely to have an
occupation (71% of treated patients had an occupation at the time of the survey versus 56% of
untreated patients, p