Food Security The dynamic described above applies also to households whose livelihood depends on agricultural production. This hypothesis is based on several observations: Some empirical evidence from the region bears out this hypothesis.
See other articles in PMC that cite the published article. Abstract In resource-limited settings, illness can impose a major financial burden on patients and their families.
Beyond the direct costs of medications, monitoring, and medical care, additional costs include the long-term lost earnings of HIV-infected individuals as well as of their household members who also provide care.
A clearer understanding of the financial burden of healthcare for HIV-infected Indians can allow policy makers and planners to better allocate limited resources.
This article reviews the financial consequences of HIV care and treatment on individuals and their households by examining current treatment options, HIV monitoring, the clinical course of HIV disease, and the roles of the private and public sector in providing HIV care in India.
Future studies should more thoroughly examine the financial impact of HIV-related costs incurred by households over time and examine household responses to these costs.
Although the epidemic in India was first detected in specific populations with higher risk of exposure to HIV, such as female sex workers, truck drivers, and injecting drug users IDUinfection has now spread into the general population in both urban and rural areas 45. Three quarters of HIV-infected women in India become infected within a few years of marriage 6and married monogamous women have increasingly reported to antenatal testing with HIV infection 57.
With the advent of effective combination antiretroviral therapy ARTmorbidity and mortality related to HIV have dramatically dropped in the developed and developing world 89. The most common AIDS-defining illness has been pulmonary tuberculosis; patients can also develop a range of adverse events associated with therapy 3.
In considering the implications of HIV disease, much attention has been focused on its clinical and therapeutic aspects, including the virus, mechanism of transmission between individuals, development of vaccines, treatment of opportunistic infections, and the development of antiretroviral drugs.
However, AIDS is now fundamentally a chronic treatable disease with far reaching economic and social consequences, and hence it is crucial to also examine the long-term financial impact of HIV healthcare on infected individuals and their families and communities. In resource-limited settings, illness can impose a major burden on patients and their families There is still a dearth of research examining the financial impact of HIV at different disease stages on individuals, families, and households in India The purpose of this article is to review the financial consequences of HIV care and treatment on individuals and their households by examining current treatment options, HIV monitoring, the clinical course of HIV disease, and the roles of the private and public sector in providing HIV care in India.
Availability of antiretroviral therapy Due to the decreasing cost of antiretroviral medications ARVsthe number of HIV-infected individuals who have access to these life-saving drugs has risen sharply in resource-limited settings over the past several years Though early on it was questioned whether generic ARVs would be as efficacious as their proprietary equivalents, studies conducted in India have demonstrated the safety, tolerability, and effectiveness of generic ART In the early years of effective treatment, ARVs were only available in developed countries at an annual cost of up to Rs.
Given that the annual per capita income in India is Rs. India has one of the largest global burdens of HIV-infected individuals who need but who do not have access to these life-saving drugs Increasing access to ART has translated into a substantial increase in public sector healthcare spending to provide these drugs to patients for free or at further subsidized rates Though funding from external donors has helped provide ART to more Indians, it has not eliminated the resource constraint of the government.
By the beginning ofapproximately 56, people were receiving ART, consisting of an initial regimen of stavudine or zidovudine, lamivudine, and nevirapine through the government programme, and 10, to 20, people were receiving ART through other sources, including from the private sector and non governmental organizations NGOs National ART centers are currently located only in districts in high and medium prevalence areas and have stringent enrollment criteria.
Government ART centers request the presence of a family member at the time of initiating ART to take responsibility for ensuring that the patient maintains adequate follow up. Patients who do not meet these criteria or who are too ill to undergo prolonged entry into government hospitals often take advantage of NGO services for their ART In addition, there are some individuals who prefer to access the services at private centers and NGOs for other reasons, such as confidentiality, convenience, time constraints, or more personalized care 23 Hence, HIV-infected individuals may be spending severely limited financial resources on treatment regimens that may provide limited clinical benefit as well as increase the potential for drug resistance, necessitating more expensive second-line treatment regimens.
The changing cost of ARVs in India Despite continued efforts to provide low cost treatment in India through sources such as the Global Fund to Fight AIDS, Tuberculosis and Malaria funded by government, civil society, and the private sectorclinical trials, and the production of generic ARVs in India, the fact that many HIV-infected Indians are still unable to access treatment due to cost highlights the need for further efforts to develop more cost-effective treatment methods.
Despite the costs that can be associated with ARVs, it appears that many Indian patients are willing to pay for them. Of those willing to be on ART, 90 per cent were willing to pay for drugs, 74 per cent for initial tests, and 83 per cent for follow-up tests The cost-effectiveness of three-drug antiretroviral therapy regimens has been clearly established in the developed world 27 — Yet strategies that are identified as cost-effective may be unaffordable for the very poor without further assistance.
However, starting a protease inhibitor PI rather than a nonnucleoside reverse transcriptase inhibitor NNRTI based regimen was very expensive, without substantial added efficacy Further studies in resource-limited settings are needed to more clearly understand the optimal timing of initiating treatment, as well as switching to second-line therapy and the most effective way to decrease treatment failure.
The Indian pharmaceutical industry does produce second-line protease inhibitor medications, but the cost can be 5—8 times that of first-line drugs. The huge price disparity between first- and second-line regimens can be of great concern for Indian patients failing first-line regimens Additionally, second-line protease inhibitor regimens can pose other challenges in resource-limited settings, such as a more complex dosing schedules, drug interactions, and toxicities.
In the present scenario of limited access to adequate second-line therapy, many Indian patients continue to take failing first-line regimens due to the prohibitive costs of second-line treatment regimens.
Adherence to antiretroviral therapy Given that medical insurance does not cover ART and government treatment programmes are limited, many Indian patients are left to fund their own treatment.in the United States and to discuss efforts to reduce the burden of opioid abuse and misuse.
Economic Burden of Prescription Opioid Misuse and Abuse lines calling attention to the prevalence of undertreated pain. ,30,31 Mentions of fentanyl abuse increased the most (%), AIDS. Another important result is that, despite the low HIV/AIDS prevalence, its economic burden is very relevant in terms of the total health care costs in this five countries.
This study also shows that there are relatively few studies of HIV costs in European countries compared to other diseases.
Thus, factors, such as the financial burden of patients, care policy and compliance should be generally considered when initiating HAART.
In our study, we pooled the data from two distinct programs, the only difference in program design of which was the enrollment criteria for CD4 cell counts.
Therefore, understanding the financial burden of HIV/AIDS is necessary to develop protective mechanisms, and improve efficiency of the health‐care system.
In Vietnam, an estimated , people have HIV/AIDS, and 30% require ART at the treatment eligibility criterion of a CD4 count of.
Financial impact of HIV/AIDS in America and Canada. Canada$ Billion Cost for in Canada: "June , Halifax, Nova Scotia--HIV/AIDS cost Canadians more than $2 . The states with highest number of new diagnoses in , and thus the greatest financial burden, were Florida, California, New York, and Texas.
In all, the total lifetime treatment cost for HIV based on new diagnoses in was estimated to be $ billion.