Free access to antiretroviral treatment and protection against the risk of catastrophic health expenditure in people living with HIV: evidence from Cameroon
Open Access
- 7 April 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Health Services Research
- Vol. 21 (1), 1-7
- https://doi.org/10.1186/s12913-021-06331-5
Abstract
To foster access to care and reduce the burden of health expenditures on people living with HIV (PLHIV), several sub-Saharan African countries, including Cameroon, have adopted a policy of removing HIV-related fees, especially for antiretroviral treatment (ART). We investigate the impact of Cameroon’s free antiretroviral treatment (ART) policy, enacted in May 2007, on catastrophic health expenditure (CHE) risk according to socioeconomic status, in PLHIV enrolled in the country’s treatment access program. Based on primary data from two cross-sectional surveys of PLHIV outpatients in 2006–2007 and 2014 (i.e., before and after the policy’s implementation, respectively), we used inverse propensity score weighting to reduce covariate imbalances between participants in both surveys, combined with probit regressions of CHE incidence. The analysis included participants treated with ART in one of the 11 HIV services common to both surveys (n = 1275). The free ART policy was associated with a significantly lower risk of CHE only in the poorest PLHIV while no significant effect was found in lower-middle or upper socioeconomic status PLHIV. Unexpectedly, the risk of CHE was higher in those with middle socioeconomic status after the policy’s implementation. Our findings suggest that Cameroon’s free ART policy is pro-poor. As it only benefitted PLHIV with the lowest socioeconomic status, increased comprehensive HIV care coverage is needed to substantially reduce the risk of CHE and the associated risk of impoverishment for all PLHIV.This publication has 19 references indexed in Scilit:
- A literature review of the disruptive effects of user fee exemption policies on health systemsBMC Public Health, 2012
- Does HIV Services Decentralization Protect against the Risk of Catastrophic Health Expenditures? Some Lessons from CameroonHealth Services Research, 2011
- Non-adherence to antiretroviral treatment and unplanned treatment interruption among people living with HIV/AIDS in Cameroon: Individual and healthcare supply-related factorsSocial Science & Medicine (1982), 2011
- Scaling up access to antiretroviral treatment for HIV infection: the impact of decentralization of healthcare delivery in CameroonAIDS, 2010
- Can insurance increase financial risk?: The curious case of health insurance in ChinaJournal of Health Economics, 2008
- Inverse probability weighted estimation for general missing data problemsJournal of Econometrics, 2007
- To Retain or Remove User Fees?Applied Health Economics and Health Policy, 2006
- Poverty and HIV/AIDS in AfricaThird World Quarterly, 2002
- Semiparametric Efficiency in Multivariate Regression Models with Missing DataJournal of the American Statistical Association, 1995
- The central role of the propensity score in observational studies for causal effectsBiometrika, 1983