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The impact of immediate initiation of antiretroviral therapy on Patients’ healthcare expenditures: a stepped-wedge randomized trial in eswatini

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Steinert, Janina I., Khan, Shaukat, Mafara, Emma, Wong, Cebele, Mlambo, Khudzie, Hettema, Anita, Walsh, Fiona J., Lejeune, Charlotte +7 more·2021·AIDS and Behavior
DOI 10.1007/s10461-021-03241-9PMC PMC8416844
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Abstract

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.

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Cited by

Sorted by citations

Authors
Steinert, J. I., Khan, S., Mafara, E., Wong, C., Mlambo, K., Hettema, A., Walsh, F. J., Lejeune, C., Mazibuko, S., Okello, V., Ogbuoji, O., De Neve, J.-W., Vollmer, S., Bärnighausen, T., & Geldsetzer, P.
Affiliations
  • Technical University of Munich (DE)
  • Clinton Health Access Initiative (US)
  • Ministry of Health (SZ)
  • Duke University (US)
  • Heidelberg University (DE)
Corresponding author
Steinert, Janina I.
ORCID
Venue
AIDS and Behavior
Publisher
Springer Science and Business Media LLC
Published
2021-04-08
Volume
25
Issue
10
Pages
3194-3205
ISSN
  • 1090-7165 (ISSN-L)
  • 1573-3254
DOI
10.1007/s10461-021-03241-9
PMC
PMC8416844
OpenAlex
W3148612930
Cited by
6
References
3
Citations by year
2026: 1 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 1
FWCI
0.40
Type
journal article
Language
en
Open access
Licence
Locations
  • AIDS and Behavior (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
  • mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion, other-oa)
  • mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion, cc-by)
  • GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
Funders
  • Dutch Postcode Lottery
  • Alexander von Humboldt-Stiftung
  • Embassy of the Kingdom of the Netherlands in South Africa/Mozambique
  • British Columbia Centre of Excellence in Canada
  • Médecins Sans Frontières
  • Joachim Herz Stiftung
  • National Center for Advancing Translational Sciences of the National Institutes of Health (KL2TR003143)
  • Technische Universität München
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › HIV/AIDS Impact and Responses
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
Keywords
HIV, health care expenditure, out-of-pocket costs, Swaziland, economic burden of HIV
MeSH terms
Health Expenditures, Humans, Eswatini, HIV Infections, CD4 Lymphocyte Count, Anti-HIV Agents

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