title: Co-financing for viral load monitoring during the course of antiretroviral therapy among patients with HIV/AIDS in Vietnam: A contingent valuation survey.
abstract: BACKGROUND
  Viral load testing is considered the gold standard for monitoring HIV treatment; however, given its high cost, some patients cannot afford viral load testing if this testing is not subsidized. Since foreign aid for HIV/AIDS in Vietnam is rapidly decreasing, we sought to assess willingness to pay (WTP) for viral load and CD4 cell count tests among HIV-positive patients, and identified factors that might inform future co-payment schemes.
  
  
  METHODS
  A multi-site cross-sectional survey was conducted with 1133 HIV-positive patients on antiretroviral therapy (ART) in Hanoi and Nam Dinh. Patients' health insurance coverage, quality of life, and history of illicit drug use were assessed. A contingent valuation approach was employed to measure patients' WTP for CD4 cell count and viral load testing.
  
  
  RESULTS
  HIV-positive patients receiving ART at provincial sites reported more difficulty obtaining health insurance (HI) and had the overall the poorest quality of life. Most patients (90.9%) were willing to pay for CD4 cell count testing; here, the mean WTP was valued at US$8.2 (95%CI = 7.6-8.8 US$) per test. Most patients (87.3%) were also willing to pay for viral load testing; here, mean WTP was valued at US$18.6 (95%CI = 16.3-20.9 US$) per test. High income, high education level, and hospitalization were positively associated with WTP, while co-morbidity with psychiatric symptoms and trouble paying for health insurance were both negatively related to WTP.
  
  
  CONCLUSIONS
  These findings raise concerns that HIV-positive patients in Vietnam might have low WTP for CD4 cell count and viral load testing. This means that without foreign financial subsidies, many of these patients would likely go without these important tests. Treating psychiatric co-morbidities, promoting healthcare services utilization, and removing barriers to accessing health insurance may increase WTP for monitoring of HIV/AIDS treatment among HIV+-positive Vietnamese patients.
authors.affiliation: Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
authors.forename: Quyen Le Thi
authors.initials: QL
authors.lastname: Nguyen
authors.affiliation: School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
authors.forename: Long Hoang
authors.identifier: http://orcid.org/0000-0003-1658-2394
authors.initials: LH
authors.lastname: Nguyen
authors.affiliation: Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.|Department of Immunology and Allergy, National Otolaryngology Hospital, Hanoi, Vietnam.
authors.forename: Bach Xuan
authors.initials: BX
authors.lastname: Tran
authors.affiliation: Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam.
authors.forename: Huong Thi Thu
authors.initials: HT
authors.lastname: Phan
authors.affiliation: Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
authors.forename: Huong Thi
authors.initials: HT
authors.lastname: Le
authors.affiliation: Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
authors.forename: Hinh Duc
authors.initials: HD
authors.lastname: Nguyen
authors.affiliation: Department of Hepatobiliary Surgery, Viet-Duc Hospital, Hanoi, Vietnam.
authors.forename: Tho Dinh
authors.initials: TD
authors.lastname: Tran
authors.affiliation: Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam.
authors.forename: Cuong Duy
authors.initials: CD
authors.lastname: Do
authors.affiliation: Department of International Affairs, Ministry of Health, Hanoi, Vietnam.
authors.forename: Cuong Manh
authors.initials: CM
authors.lastname: Nguyen
authors.affiliation: Department of Immunology and Allergy, National Otolaryngology Hospital, Hanoi, Vietnam.
authors.forename: Vu Thi Minh
authors.initials: VT
authors.lastname: Thuc
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America.
authors.forename: Carl
authors.initials: C
authors.lastname: Latkin
authors.affiliation: Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore, Singapore, Singapore.
authors.forename: Melvyn W B
authors.initials: MW
authors.lastname: Zhang
authors.affiliation: Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Roger C M
authors.initials: RC
authors.lastname: Ho
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000191:economics* / Q000821:virology; D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count / Q000191:economics; D003430:Cross-Sectional Studies; D005260:Female; D005382:Financing, Personal; D006678:HIV / Q000378:metabolism; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000821:virology; D006801:Humans; D007182:Income; D007348:Insurance, Health; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011788:Quality of Life; D012923:Social Class; D011795:Surveys and Questionnaires; D014744:Vietnam; D019562:Viral Load / Q000191:economics*; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents