title: Financial barriers to HIV treatment in Yaoundé, Cameroon: first results of a national cross-sectional survey.
abstract: 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.
authors: INSERM / IRD U912 (SE4S), Université Aix Marseille, 23 rue Stanislas Torrents, Marseille, France. sylvie.boyer@inserm.fr
authors: Sylvie
authors: S
authors: Boyer
authors: Fabienne
authors: F
authors: Marcellin
authors: Pierre
authors: P
authors: Ongolo-Zogo
authors: Séverin-Cécile
authors: SC
authors: Abega
authors: Robert
authors: R
authors: Nantchouang
authors: Bruno
authors: B
authors: Spire
authors: Jean-Paul
authors: JP
authors: Moatti
mesh_terms: 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
chemical_list: D044966:Anti-Retroviral Agents