Abstract
BackgroundViral load testing is considered the gold standard for monitoring HIV treatment; however, given its high cost, some patients cannot afford viral load testing if this testing is not subsidized. Since foreign aid for HIV/AIDS in Vietnam is rapidly decreasing, we sought to assess willingness to pay (WTP) for viral load and CD4 cell count tests among HIV-positive patients, and identified factors that might inform future co-payment schemes.MethodsA multi-site cross-sectional survey was conducted with 1133 HIV-positive patients on antiretroviral therapy (ART) in Hanoi and Nam Dinh. Patients’ health insurance coverage, quality of life, and history of illicit drug use were assessed. A contingent valuation approach was employed to measure patients’ WTP for CD4 cell count and viral load testing.ResultsHIV-positive patients receiving ART at provincial sites reported more difficulty obtaining health insurance (HI) and had the overall the poorest quality of life. Most patients (90.9%) were willing to pay for CD4 cell count testing; here, the mean WTP was valued at US$8.2 (95%CI = 7.6–8.8 US$) per test. Most patients (87.3%) were also willing to pay for viral load testing; here, mean WTP was valued at US$18.6 (95%CI = 16.3–20.9 US$) per test. High income, high education level, and hospitalization were positively associated with WTP, while co-morbidity with psychiatric symptoms and trouble paying for health insurance were both negatively related to WTP.ConclusionsThese findings raise concerns that HIV-positive patients in Vietnam might have low WTP for CD4 cell count and viral load testing. This means that without foreign financial subsidies, many of these patients would likely go without these important tests. Treating psychiatric co-morbidities, promoting healthcare services utilization, and removing barriers to accessing health insurance may increase WTP for monitoring of HIV/AIDS treatment among HIV+-positive Vietnamese patients.
Highlights
Regular monitoring of HIV-positive patients on antiretroviral therapy (ART) is a critical component of HIV/AIDS care
Participants recruited from central HIV/AIDS clinics were mroe likely to be male (65%) and were more likely to live with a spouse/partner (64.6% in the central clinics vs 55% in the provincial clinics)
Participants recruited from central HIV/AIDS clinics had the highest level of education, with 35.7% having completed higher levels of education
Summary
Regular monitoring of HIV-positive patients on antiretroviral therapy (ART) is a critical component of HIV/AIDS care. Monitoring can promptly inform clinicians if patients have poor responses to treatment, reducing the risk of development of resistance to ARTs, transmission of HIV to others, and premature morbidity and mortality due to the virus [1]. Promotion of regular viral load and CD4 cell count monitoring is an important extension of existing ART programs, especially in developing countries [2]. In terms of HIV treatment, previously, patients were started on ART when their CD4 counts went below 500 cells/mm3 [9]. Since foreign aid for HIV/AIDS in Vietnam is rapidly decreasing, we sought to assess willingness to pay (WTP) for viral load and CD4 cell count tests among HIV-positive patients, and identified factors that might inform future co-payment schemes
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