title: Paying the price in an era of HIV treatment as prevention: a retrospective study of the cost burden of HIV treatment for people living with HIV in Victoria, Australia.
abstract: Background An estimated 25700 people live with diagnosed HIV (PLWH) in Australia and ~1200 newly diagnosed cases were notified in 2012. New HIV prevention strategies focus on individual uptake of treatment; however, a potential barrier is the financial burden of antiretroviral treatment (ART). We describe HIV ART dispensed and the estimated associated costs for PLWH in Victoria.
  
  
  METHODS
  A retrospective cross-sectional study of pharmacy data on ART dispensed between January 2012 and November 2013 from a hospital network, including Victoria's largest sexual health clinic was conducted. Estimated annual patient costs of ART were calculated by the number of items dispensed per year, concession status, dispensing site and applicable co-payment.
  
  
  RESULTS
  A total of 60225 dispensing records from 3903 individuals were included; this represented 83.8% of pharmaceutical benefits scheme-recorded ART dispensed in Victoria over this period. The estimated annual co-payment costs for patients without a concession card and who were collecting two medications was $433.20. One-fifth of patients (21.3%) collected four or more items, equating to an estimated annual cost of at least $866.40 without a concession card and $141.60 with a concession card. Of those dispensed four or more items, 40.4% were concession card holders.
  
  
  CONCLUSIONS
  There may be meaningful patient costs associated with accessing ART for some PLWH. New HIV treatment-based prevention strategies need to consider financial vulnerabilities and appropriately targeted initiatives to alleviate patient costs associated with ART, ensuring they do not act as a barrier to commencement of and adherence to HIV treatment.
authors.affiliation: Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Wilkinson
authors.affiliation: Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia.
authors.forename: James
authors.initials: J
authors.lastname: McMahon
authors.affiliation: Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia.
authors.forename: Yik-Siang
authors.initials: YS
authors.lastname: Cheah
authors.affiliation: Alfred Health, Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia.
authors.forename: Catriona S
authors.initials: CS
authors.lastname: Bradshaw
authors.affiliation: Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia.
authors.forename: Carol
authors.initials: C
authors.lastname: El-Hayek
authors.affiliation: Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Stoové