Economic burden of depressive disorders for people living with HIV in Uganda

Abstract

IntroductionBetween 8–39 % of people living with HIV (PLWH) in sub-Saharan Africa have depressive disorders (DD). Despite considerable gains in the treatment of PLWH, DD is increasingly recognised as a threat to successful treatment and prevention. PLWH are generally known to suffer from stress and incur higher health-related costs compared to the general population due to care management demand throughout their lifespan. There have been limited studies examining healthcare costs borne by PLWH with DD specifically.ObjectiveWe aimed to estimate the economic burden of DD and HIV amongst PLWH and explore their mechanisms of coping with high out of pocket (OOP) health expenditure.MethodologyThis is a cost of illness study nested in an ongoing cluster-randomised trial assessing the effectiveness of integrating treatment of DD into routine HIV care in Uganda (HIV+D trial). The study is using cross-sectional data collected from 1,115 PLWH at trial baseline, using the Patient Health Questionnaire (PHQ-9) to measure DD and a structured cost questionnaire was administered. Forty public health care facilities that provide HIV care in Kalungu, Masaka and Wakiso Districts were randomly selected, and study participants were recruited amongst their patients. Eligibility criteria were patients attending the HIV clinic, aged ≥ 18 years who screen positive for DD (PHQ-9 ≥ 10). Economic costs (OOP expenditure and opportunity costs) were estimated from the household perspective.ResultsMean monthly economic costs amongst those incurring any costs (n=1,115) were UGX 255,910 (US$ 68.64). Mean monthly OOP expenditures were UGX 94,500 (US$ 25.60). On average, respondents missed 6 days of work per month due to healthcare seeking or ill-health for any condition. Key cost drivers were facility bed charges and medication. The majority of respondents (73%) borrowed money from families and friends to cope with the economic burden. About 29.7% reported moderate (PHQ-9 15-19) and 5.12% severe (PHQ-9 ≥ 20) DD symptoms. Respondents with moderate or severe DD had slightly higher average monthly costs than those with mild DD (PHQ-10-14), but the difference was not statistically significant.ConclusionPeople living with HIV who experience DD incur in high OOP expenditure and productivity losses. The monthly OOP health expenditure is in the range of 23% of their monthly household income. Social protection mechanisms combined with the integration of the management of DD into routine HIV care could alleviate this burden.