Health expenditure and catastrophic spending among older adults living with HIV

2016 ◽  
Vol 12 (10) ◽  
pp. 1282-1296 ◽  
Author(s):  
Joel Negin ◽  
Madeleine Randell ◽  
Magdalena Z. Raban ◽  
Makandwe Nyirenda ◽  
Sebastiana Kalula ◽  
...  
2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S715-S715
Author(s):  
Chigozie A Nkwonta ◽  
Monique Brown ◽  
Titilayo James ◽  
Amandeep Kaur

Abstract Background Intersectional stigma is based upon co-occurring and intersecting identities or conditions and occurs at multiple levels of influence. Intersectional stigma has been repeatedly associated with poor health behaviors and outcomes. The effect of intersectional stigma among older adults are particularly challenging due to issues related to ageism, loss of social support, and comorbidities. We examined the impact of multiple stigmas on older adults living with HIV who are victims of childhood sexual abuse. Methods Semi-structured interviews were conducted with a purposefully selected heterogeneous sample of 24 adults living with HIV who are 50 years and older in South Carolina. Interviews were audio-recorded, transcribed verbatim, and coded using thematic analysis. Results Participants shared experiences and perceptions of stigma and discrimination most commonly related to their HIV status and sexuality at the interpersonal/familial and community levels. Four themes emerged to explain the impact of intersectional stigma: depression, lack of HIV disclosure, limited support, and reduced intimacy. Conclusion The complexity of multiple stigmas profoundly shapes life experiences, opportunities, and mental health of older adults living with HIV. This study highlights that public health programs need to consider the impact of intersectional stigma in order to promote the wellbeing of and improve quality of life for older adults living with HIV. Disclosures All Authors: No reported disclosures


AIDS Care ◽  
2021 ◽  
pp. 1-10
Author(s):  
Chi Linh Hoang ◽  
Hai Quang Pham ◽  
Hai Thanh Phan ◽  
Bach Xuan Tran ◽  
Carl A. Latkin ◽  
...  

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marwân-al-Qays Bousmah ◽  
Marie Libérée Nishimwe ◽  
Christopher Kuaban ◽  
Sylvie Boyer

Abstract Background To foster access to care and reduce the burden of health expenditures on people living with HIV (PLHIV), several sub-Saharan African countries, including Cameroon, have adopted a policy of removing HIV-related fees, especially for antiretroviral treatment (ART). We investigate the impact of Cameroon’s free antiretroviral treatment (ART) policy, enacted in May 2007, on catastrophic health expenditure (CHE) risk according to socioeconomic status, in PLHIV enrolled in the country’s treatment access program. Methods Based on primary data from two cross-sectional surveys of PLHIV outpatients in 2006–2007 and 2014 (i.e., before and after the policy’s implementation, respectively), we used inverse propensity score weighting to reduce covariate imbalances between participants in both surveys, combined with probit regressions of CHE incidence. The analysis included participants treated with ART in one of the 11 HIV services common to both surveys (n = 1275). Results The free ART policy was associated with a significantly lower risk of CHE only in the poorest PLHIV while no significant effect was found in lower-middle or upper socioeconomic status PLHIV. Unexpectedly, the risk of CHE was higher in those with middle socioeconomic status after the policy’s implementation. Conclusions Our findings suggest that Cameroon’s free ART policy is pro-poor. As it only benefitted PLHIV with the lowest socioeconomic status, increased comprehensive HIV care coverage is needed to substantially reduce the risk of CHE and the associated risk of impoverishment for all PLHIV.


Healthcare ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 39
Author(s):  
Yuqing Liang ◽  
Wanwan Zheng ◽  
Woon-Seek Lee

Background: although China’s total health expenditure has been dramatically increased so that the country can cope with its aging population, inequalities among individuals in terms of their medical expenditures (relative to their income level) have exacerbated health problems among older adults. This study aims to examine the nonlinear associations between each of medical expenditure, perceived medical attitude, and sociodemographics, and older adults’ self-rated health (SRH); it does so by using data from the 2018 China Family Panel Studies survey. Method: we used the extreme gradient boosting model to explore the nonlinear association between various factors and older adults’ SRH outcomes. We then conducted partial dependence plots to examine the threshold effects of each factor on older adults’ SRH. Results: older adults’ medical expenditure exceeded their overall income. Body mass index (BMI) and personal health expenditure play an essential role in predicting older adults’ SRH outcomes. We found older adult age, physical exercise status, and residential location to be robust predictors of SRH outcomes in older adults. Partial dependence plots of the results visualized the nonlinear association between variables and the threshold effects of factors on older adults’ SRH outcomes. Conclusions: findings from this study underscore the importance of medical expenditure, perceived medical attitudes, and BMI as important predictors of health benefits in older adults. The potential threshold effects of medical expenditure on older adults’ SRH outcomes provide a better understanding of the formation of appropriate medical policy interventions by balancing the government and personal medical expenditure to promote health benefits among older adults.


10.2196/18588 ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. e18588
Author(s):  
Katherine Tassiopoulos ◽  
Carla Roberts-Toler ◽  
Carl J Fichtenbaum ◽  
Susan L Koletar

Background Longitudinal follow-up of older persons living with HIV is essential for the ascertainment of aging-related clinical and behavioral outcomes, and self-administered questionnaires are necessary for collecting behavioral information in research involving persons living with HIV. Web-based self-reported data collection results in higher data quality than paper-and-pencil questionnaires in a wide range of populations. The option of remote web-based surveys may also increase retention in long-term research studies. However, the acceptability and feasibility of web-based data collection in clinical research involving older persons living with HIV have never been studied. Objective This study aims to assess the acceptability and feasibility of a web-based survey to collect information on sexual, substance use, and physical activity behaviors; compare the data quality of the web-based survey with that of a paper-and-pencil questionnaire; and summarize web-based survey metrics. Methods This pilot study took place within the AIDS Clinical Trials Group A5322 study, a longitudinal cohort of men and women living with HIV (aged ≥40 years), followed at 32 clinical sites in the United States and Puerto Rico. A total of 4 sites participated in this study. A web-based survey was created using self-administered questionnaires typically completed in A5322 via paper and pencil. Pilot study participants completed these questionnaires via web-based survey at one research visit in lieu of paper-and-pencil administration. Two questions were added to assess feasibility, defined as participants’ perception of the ease of web-based survey completion (very hard, hard, easy, very easy), and their preferred format (computer or tablet, paper and pencil, no preference) for completing the questions in the future (acceptability). Feasibility and acceptability were summarized overall and by demographic and clinical characteristics; the proportion of evaluable data by web-based survey versus previously administered paper-and-pencil questionnaires (data quality) was compared for each question. Results Acceptability and feasibility were high overall: 50.0% (79/158) preferred computer or tablet, 38.0% (60/158) reported no preference, and 12.0% (19/158) preferred paper and pencil; 93.0% (147/158) reported survey completion easy or very easy. Older age was associated with lower odds of preferring computer or tablet to paper and pencil (odds ratio per 1-year increase in age: 0.91, 95% CI 0.85-0.98). Individuals who found the survey hard or very hard had a lower median neurocognitive test score than those who found it easy or very easy. Data quality with web-based survey administration was similar to or higher than that with paper-and-pencil administration for most questions. Conclusions Web-based survey administration was acceptable and feasible in this cohort of older adults living with HIV, and data quality was high. Web-based surveys can be a useful tool for valid data collection and can potentially improve retention in long-term follow-up studies.


2018 ◽  
Vol 34 (5) ◽  
pp. 449-455 ◽  
Author(s):  
Alfonso Zamudio-Rodríguez ◽  
Pablo F. Belaunzarán-Zamudio ◽  
Juan G. Sierra-Madero ◽  
Jennifer Cuellar-Rodríguez ◽  
Brenda E. Crabtree-Ramírez ◽  
...  

AIDS Care ◽  
2018 ◽  
Vol 31 (2) ◽  
pp. 243-249 ◽  
Author(s):  
Annie L. Nguyen ◽  
David Seal ◽  
Omar Bruce ◽  
Margarida Dalton ◽  
Allison Palmer ◽  
...  

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