title: The patient costs of care for those with TB and HIV: a cross-sectional study from South Africa.
abstract: BACKGROUND
  This study describes the post-diagnosis care-seeking costs incurred by people living with TB and/or HIV and their households, in order to identify the potential benefits of integrated care.
  
  
  METHODS
  We conducted a cross-sectional study with 454 participants with TB or HIV or both in public primary health care clinics in Ekurhuleni North Sub-District, South Africa. We collected information on visits to health facilities, direct and indirect costs for participants and for their guardians and caregivers. We define 'integration' as receipt of both TB and HIV services at the same facility, on the same day. Costs were presented and compared across participants with TB/HIV, TB-only and HIV-only. Costs exceeding 10% of participant income were considered catastrophic.
  
  
  RESULTS
  Participants with both TB and HIV faced a greater economic burden (US$74/month) than those with TB-only (US$68/month) or HIV-only (US$40/month). On average, people with TB/HIV made 18.4 visits to health facilities, more than TB-only participants or HIV-only participants who made 16 and 5.1 visits, respectively. However, people with TB/HIV had fewer standalone TB (10.9) and HIV (2.2) visits than those with TB-only (14.5) or HIV-only (4.4). Although people with TB/HIV had access to 'integrated' services, their time loss was substantially higher than for other participants. Overall, 55% of participants encountered catastrophic costs. Access to official social protection schemes was minimal.
  
  
  CONCLUSIONS
  People with TB/HIV in South Africa are at high risk of catastrophic costs. To some extent, integration of services reduces the number of standalone TB and HIV of visits to the health facility. It is however unlikely that catastrophic costs can be averted by service integration alone. Our results point to the need for timely social protection, particularly for HIV-positive people starting TB treatment.
authors.affiliation: The Aurum Institute, Johannesburg, 29 Queens Road, Parktown Johannesburg, Gauteng, 2193 South Africa.
authors.forename: Don
authors.initials: D
authors.lastname: Mudzengi
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
authors.forename: Sedona
authors.initials: S
authors.lastname: Sweeney
authors.affiliation: The Aurum Institute, Johannesburg, 29 Queens Road, Parktown Johannesburg, Gauteng, 2193 South Africa.
authors.forename: Piotr
authors.initials: P
authors.lastname: Hippner
authors.affiliation: The Aurum Institute, Johannesburg, 29 Queens Road, Parktown Johannesburg, Gauteng, 2193 South Africa.
authors.forename: Tendesayi
authors.initials: T
authors.lastname: Kufa
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Fielding
authors.affiliation: Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
authors.forename: Alison D
authors.initials: AD
authors.lastname: Grant
authors.affiliation: The Aurum Institute, Johannesburg, 29 Queens Road, Parktown Johannesburg, Gauteng, 2193 South Africa.
authors.forename: Gavin
authors.initials: G
authors.lastname: Churchyard
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Vassall
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000191:economics* / Q000628:therapy; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011203:Poverty; D016032:Randomized Controlled Trials as Topic; D013019:South Africa; D014376:Tuberculosis / Q000191:economics* / Q000628:therapy
keywords: HIV; integration; patient costs; poverty; tuberculosis