ArticleJournal of acquired immune deficiency syndromes (1999)2015
Time and Money: The True Costs of Health Care Utilization for Patients Receiving "Free" HIV/Tuberculosis Care and Treatment in Rural KwaZulu-Natal.
Article in Journal of acquired immune deficiency syndromes (1999), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 66 papers, 4 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
66 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Care Cascades for Hypertension in Low-Income Settings: A Systematic Review and Meta-Analysis.International journal of public health · 2023Pooled it
- The per-patient costs of HIV services in South Africa: Systematic review and application in the South African HIV Investment Case.PloS one · 2019Pooled it
- Why do people living with HIV not initiate treatment? A systematic review of qualitative evidence from low- and middle-income countries.Social science & medicine (1982) · 2018Pooled it
- A systematic review of interventions to improve postpartum retention of women in PMTCT and ART care.Journal of the International AIDS Society · 2016Pooled it
- Evaluating the impact of conditional micro-incentives on linkage to HIV care in rural South Africa: results from the Home-Based Intervention to Test and Start (HITS) trial.Health policy and planning · 2026Trial
- Economic Burden of Human Immunodeficiency Virus and Hypertension Care Among MOPHADHIV Trial Participants: Patient Costs and Determinants of Out-of-Pocket Expenditure in South Africa.International journal of environmental research and public health · 2025Trial
- Economic outcomes among microfinance group members receiving community-based chronic disease care: Cluster randomized trial evidence from Kenya.Social science & medicine (1982) · 2024Trial
- The Impact of Immediate Initiation of Antiretroviral Therapy on Patients' Healthcare Expenditures: A Stepped-Wedge Randomized Trial in Eswatini.AIDS and behavior · 2021Trial
- Trial
- Community delivery of antiretroviral drugs: A non-inferiority cluster-randomized pragmatic trial in Dar es Salaam, Tanzania.PLoS medicine · 2018Trial
- The impact of community health worker-led home delivery of antiretroviral therapy on virological suppression: a non-inferiority cluster-randomized health systems trial in Dar es Salaam, Tanzania.BMC health services research · 2017Trial
- Public Oral Healthcare Utilisation and Its Associated Factors in Malaysian Adults: A Time-Series Analysis (1992-2019).International dental journal · 2026Article
- Experiences of Community Members and Health Workers Regarding Malaria Control Programmes in the Rural Ingwavuma Community, uMkhanyakude District Municipality, KwaZulu-Natal Province, South Africa.Public health challenges · 2025Article
- The catastrophic cost of TB care: Understanding costs incurred by individuals undergoing TB care in low-, middle-, and high-income settings - A systematic review.PLOS global public health · 2025Article
- Depression: an individual-level early warning indicator of virologic failure in HIV patients in South Africa.Public health action · 2024Article
- Article
- Screening for post-TB lung disease at TB treatment completion: Are symptoms sufficient?PLOS global public health · 2024Article
- Disease awareness and healthcare utilization in rural South Africa: a comparative analysis of HIV and diabetes in the HAALSI cohort.BMC public health · 2023Article
- Intergenerational spillover effects of antiretroviral therapy in sub-Saharan Africa: a scoping review and future directions for research.BMJ global health · 2023Article
- Patient satisfaction with chronic disease care and its associated factors in primary health care facilities in Johannesburg, South Africa.Frontiers in health services · 2023Article
6 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
backgroundHIV and tuberculosis (TB) services are provided free of charge in many sub-Saharan African countries, but patients still incur costs.
methodsPatient-exit interviews were conducted in primary health care clinics in rural South Africa with representative samples of 200 HIV-infected patients enrolled in a pre-antiretroviral treatment (pre-ART) program, 300 patients receiving antiretroviral treatment (ART), and 300 patients receiving TB treatment. For each group, we calculated health expenditures across different spending categories, time spent traveling to and using services, and how patients financed their spending. Associations between patient group and costs were assessed in multivariate regression models.
resultsTotal monthly health expenditures [1 USD = 7.3 South African Rand (ZAR)] were ZAR 171 [95% confidence interval (CI): 134 to 207] for pre-ART, ZAR 164 (95% CI: 141 to 187) for ART, and ZAR 122 (95% CI: 105 to 140) for TB patients (P = 0.01). Total monthly time costs (in hours) were 3.4 (95% CI: 3.3 to 3.5) for pre-ART, 5.0 (95% CI: 4.7 to 5.3) for ART, and 3.2 (95% CI: 2.9 to 3.4) for TB patients (P < 0.01). Although overall patient costs were similar across groups, pre-ART patients spent on average ZAR 29.2 more on traditional healers and ZAR 25.9 more on chemists and private doctors than ART patients, whereas ART patients spent ZAR 34.0 more than pre-ART patients on transport to clinics (P < 0.05 for all results). Thirty-one percent of pre-ART, 39% of ART, and 41% of TB patients borrowed money or sold assets to finance health care.
conclusionsPatients receiving nominally free care for HIV/TB face large private costs, commonly leading to financial distress. Subsidized transport, fewer clinic visits, and drug pick-up points closer to home could reduce costs for ART patients, potentially improving retention and adherence. Large expenditure on alternative care among pre-ART patients suggests that transitioning patients to ART earlier, as under HIV treatment-as-prevention policies, may not substantially increase patients' financial burden.
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