HIV continues to increase the burden on already over-stretched health services in developing countries. DFID-funded research involving the UK's Liverpool School of Tropical Medicine assessed the economic burden of HIV/AIDS on medical services at Kenyatta National Hospital, Nairobi, Kenya.

Clinical care for people with HIV in Kenya is currently limited to basic management of acute HIV-related infections. There is minimal access to primary disease prophylaxis or antiretroviral therapy, and little specific treatment of opportunistic infections. However, the increase in demand for basic care alone is likely to have a major impact on the ability of resource-poor countries to provide adequate healthcare. Potential problems include:

• increased admissions of HIV-positive patients leading to overcrowding
• greater demands on medical staff
• strains on other hospital and healthcare resources
• shortfalls in drug supplies.

The researchers analysed records from 398 patients admitted to the medical ward over a 14-week period. They found that:

• 35 percent of total healthcare costs are non-curative, 32 percent are staff costs, 21 percent cover investigations and 11 percent pay for drugs.
• The mean length of stay is 9.3 days; the median is 6 days. The mean cost per patient admission is $163.
• There is no difference in either cost or length of stay between patients with and without HIV or between HIV-positive patients with clinical AIDS and those without.
• The charges paid by patients average $61 each or $78 including the purchase of drugs.
• Of the 102 patients known to have a National Health Insurance Fund card, only 29 were recorded as having made claims and having been partly or wholly reimbursed.

The cost patterns may be the same for patients with and without HIV in each admission because the hospital currently provides only basic acute medical services with no specific provision for AIDS-related problems. However, because HIV/AIDS patients suffer numerous episodes of ill-health, lifetime costs of care will be greater. Patients bear a large portion of the cost burden, including treatment, home care, loss of earnings and productivity, outpatient follow-up services and onward referral. Healthcare costs have a significant impact on household expenditures and savings, and as they rise they can restrict access to health services.

When planning care strategies and the introduction of new, more costly therapies, health policy-makers should consider not only their affordability from the provider's perspective, but also patients' ability to pay and the nature of existing payment systems. Assessing the resources needed at a national level to provide adequate care as HIV prevalence increases requires better knowledge of:

• costs of addressing gaps in service provision
• alternative models of care
• health-seeking behaviour of HIV-positive patients.

Source(s):
'Costs of hospital care for HIV-positive and HIV-negative patients at Kenyatta National Hospital, Nairobi, Kenya', AIDS 16: 1-8, by L. Guinness, G. Arthur, S. Bhatt, G. Achia, S. Kariuki and C. Gilks, 2002
HINARI subscribers can access the full-text article here. Full document.

Funded by: UK Department for International Development

id21 Research Highlight: 21 May 2002

Further Information:
Charles Gilks
HIV/AIDS Department
World Health Organisation
20 Avenue Appia
CH-1211 Geneva 27
Switzerland

Tel: +41 22 791 4599
Fax: +41 22 791 4834
Contact the contributor: gilksc@who.ch

World Health Organisation

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