A Study On The Relationship Between Comorbidities And The Economic Burden Of Disease In People Living With HIV And AIDS

Background/Objectives: HIV/AIDS has caused a heavy burden on society and is a public health issue to which China attaches great importance.Prolonged survival and long-term drug use increase the risk of other chronic diseases.The coexistence of multiple diseases affects the cost of treatment for AIDS-related illnesses and adversely affects productivity and quality of life.Community clinics are the main providers of antiretroviral services,and their ability to deliver services may have an impact on the health and economic burden of infected people.The purpose of this study is to explore the impact of comorbidities on the economic burden of People living with HIV and AIDS(PLWHA)in the Sichuan Province Comprehensive AIDS Prevention and Control Demonstration Area,and to test whether the impact of comorbidities on direct economic burden and intangible economic burden is adjusted by factors at the treatment point level.Methods: This study used data from the survey in the Sichuan Province AIDS Prevention and Control Demonstration Area,a total of 600 samples from 22 community clinics were included.First,the study measured the economic burden of disease of PLWHA.Second,The Two-Part Model(TPM)method is used to obtain the proportion of direct economic burden that can be attributed to comorbidities.The Hierarchi Linear Model(HLM)was used to control the differences at the treatment point level,identify the impact of comorbidities on the direct and intangible economic burden of infected patients,and explore the interaction effect between treatment points and comorbidities on direct and intangible economic burden.Results:A total of 194 samples had comorbidities.The direct economic burden of some samples was low,and the direct economic burden between the samples varied greatly,and 6.6% of the direct economic burden incurred could be attributed to comorbidities.In total,the sample caused an indirect economic burden of more than 30 million RMB.The average quality of life utility of infected people is worth a score of 0.92,and the degree of intangible economic burden is average.The K-W test found a difference in disability loss life years(p<0.001)but no difference in indirect economic burden(p>0.05)among infected people with comorbid disease.The results of the TPM found that 6.6% of the direct economic burden can be attributed to comorbidities.The results of the HLM showed that the effect of comorbidity on direct economic burden was not significant(p>0.05),the number of staff(β=0.471,p<0.05)and the number of staff participating in training(β=-0.158,p<0.01)had a significant effect on the direct economic burden of comorbid PLWHA.The intangible economic burden of samples with comorbidities was higher than samples without comorbidities(p<0.001).The distance from the treatment point to the designated hospital(β=-0.099,p<0.001),the highest professional title of the staff(β=-0.148,p<0.01)and whether follow-up calls are reimbursed(β=0.076,p<0.001)have a significant role in regulating the invisible economic burden of comorbid infections.Conclusion: Comorbidities can lead to higher intensity of direct economic burden,as well as more problems with limited mobility,anxiety,and depression.To improve the current economic burden of diseases among infected people,it is necessary to ensure the compliance of this population with antiviral treatment,strengthen health education,pay attention to the quality of life,enhance the service capacity of grassroots treatment points,and provide differentiated antiviral treatment services for infected people.