The Economic Burden Analysis Of People Living With HIV/AIDS From The Men Who Have Sex With Men

Objectives:There are no studies of the patient costs for antiretroviral therapy (ART) for MSM in China. In the present era, Men who have sex with men (MSM) are increasing part of the HIV epidemic in China, particularly in large cities. In Jiangsu province, MSM make the majority of new HIV diagnoses. We therefore conducted a cost analysis of ART treatment including all eligible MSM in three cities in Jiangsu. To study the economic burden of HIV/AIDS patients who were confirmed to be infected by homosexual behavior. To explore the factors that may affect the economic burden of antiretroviral therapy. At the same time, we want to study the current health care security policy and the popularity.Methods(1) Questionnaire:Overall study design:Cost analysis from the prospective of MSM patients on ART, including direct and indirect costs incurred in the calendar year 2014.Study population and recruitment:Eligibility criteria:male, MSM category, reported to the national case based surveillance system, resident and receiving care in 3 cities (Nanjing, Zhenjiang, Wuxi), and had taken ART for at least one year (that is, initiated ART on or before 31 December,2013). All cases meeting these criteria were identified and contacted through their care clinics. Interviewed at the time of picking up medicine.Measures:describe variables, demographic, behavioral, clinical, ART use. Describe more details of costs (the direct economic burden and the indirect economic burden).(2) Qualitative interview:The doctors who have engaged in HIV/AIDS treatment for many years in the three cities were interviewed to study the situation of current health care security policy and its popularity.(3) Analysis:Descriptive statistics of characteristics by frequency, percent, means and medians. Costs are presented as medians due to lack of a normal distribution. Nonetheless, means are also shown to highlight differences not seen by medians. In bivariate analysis, differences in costs between groups were compared using the non-parametric Kruskal—Wallis rank sum test. For multivariate regression analysis, the dependent cost variable as log-transformed to conform to a normal distribution.Results1. A total of 845 eligible cases are enrolled in this study:446 partipants in Nanjing,87 in Zhenjiang and 312 in Wuxi city.706 cases have some kind of health insurance, and the other 16.4% of patients can only at their own expense because of no insusurance.2. The averages frequency of outpatient and inpatient for treating the adverse reactions and opportunistic infections along with the antiretroviral therapy were 0.9 and 0.1 times respectively in the last 12 months. The average time of inpatient was 1.2 days, and the delayed days because of AIDS rest was 5.8 days in the last 12 months.3. The overall annual median of direct medical cost in the three cities in the last 12 months was 565 yuan and the average cost was 2878 yuan, with some MSM costs being in the high end of the distribution. The median of direct medical cost of Nanjing, Zhenjiang and Wuxi were 540 yuan,500 yuan and 600 yuan respectively. The mean direct medical cost of Nanjing, Zhenjiang and Wuxi were 2614 yuan,2498 yuan and 3361 yuan.The overall annual median of direct economic burden was 800 yuan, the three cities were 836 yuan,700 yuan and 800 yuan respectively. The indirect economic burden was 0 yuan. The median of total economic burden of all partipants was 932 yuan, the three cities were 1045 yuan,730 yuan and 800 yuan respectively.4. The direct economic burden and the total economic burden of Nanjing patients were much heavier than patients in Zhenjiang city and Wuxi city.5. The younger patients had more expensive cost in the three cities.6. Lower levels of the late CD4 value lead to more expensive of the direct medical cost, the direct economic burden and the total economic burden.7. The types of health insurance affected the economic burden; the patients with the new rural cooperative medical system had lower direct economic burden.8. The higher viral load made the more expenditure of direct medical cost.9. Monthly income also affects the indirect and indirect economic burden. The economic burden of patients who had more monthly income was heavier.Conclusion:Now have solid information that the economic burden is not high for MSM in the three cities.The government has no need to invest more policy to relieve the patients' pressure. And at the same time, the frequency of test of viral load should be increased.The patients are not familiar with the current supporting policies provided by the local government or related department. The regular follow-up medical institutions should strengthen propagandize to the patients with financial difficulties.