Financial barriers to HIV treatment in Yaoundé, Cameroon: first results of a national cross-sectional survey.
OBJECTIVE
To assess the extent to which user fees for antiretroviral therapy (ART) represent a financial barrier to access to ART among HIV-positive patients in Yaoundé, Cameroon.


METHODS
Sociodemographic, economic and clinical data were collected from a random sample of 707 HIV-positive patients followed up in six public hospitals of the capital city (Yaoundé) and its surroundings through face-to-face interviews carried out by trained interviewers independently from medical staff and medical questionnaires filled out by prescribing physicians. Logistic regression models were used to identify factors associated with self-reported financial difficulties in purchasing ART during the previous 3 months.


RESULTS
Of the 532 patients treated with ART at the time of the survey, 20% reported financial difficulty in purchasing their antiretroviral drugs during the previous 3 months. After adjustment for socioeconomic and clinical factors, reports of financial difficulties were significantly associated with lower adherence to ART (odds ratio, OR: 0.24; 95% confidence interval, CI: 0.15-0.40; P < 0.0001) and with lower CD4+ lymphocyte (CD4) counts after 6 months of treatment (OR: 2.14; 95% CI: 1.15-3.96 for CD4 counts < 200 cells/microl; P = 0.04).


CONCLUSIONS
Removing a financial barrier to treatment with ART by eliminating user fees at the point of care delivery, as recommended by WHO, could lead to increased adherence to ART and to improved clinical results. New health financing mechanisms based on the public resources of national governments and international donors are needed to attain universal access to drugs and treatment for HIV infection.
Boyer
Sylvie
S
INSERM / IRD U912 (SE4S), Université Aix Marseille, 23 rue Stanislas Torrents, Marseille, France. sylvie.boyer@inserm.fr
Marcellin
Fabienne
F
Ongolo-Zogo
Pierre
P
Abega
Séverin-Cécile
SC
Nantchouang
Robert
R
Spire
Bruno
B
Moatti
Jean-Paul
JP
D000328:Adult; D044966:Anti-Retroviral Agents / Q000191:economics* / Q000627:therapeutic use; D002163:Cameroon; D017047:Cost Sharing; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics*; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008297:Male
D044966:Anti-Retroviral Agents