Financial burdens of HIV and chronic disease on people living with HIV in Côte d’Ivoire: A cross-sectional out-of-pocket expenditure study

Background: Although people living with HIV in Côte d’Ivoire receive antiretroviral therapy (ART) at no cost, other out-of-pocket (OOP) spending related to health can still create a barrier to care. Methods: A convenience sample of 400 adults living with HIV for at least 1 year in Côte d’Ivoire completed a survey on their health spending for HIV and chronic non-communicable diseases (NCDs). In addition to descriptive statistics, we performed simple linear regression analyses with bootstrapped 95% confidence intervals. Findings: 365 participants (91%) reported OOP spending for HIV care, with a median of $16/year (IQR 5–48). 34% of participants reported direct costs with a median of $2/year (IQR 1–41). No participants reported user fees for HIV services. 87% of participants reported indirect costs, with a median of $17/year (IQR 7–41). 102 participants (26%) reported at least 1 NCD. Of these, 80 (78%) reported OOP spending for NCD care, with a median of $50/year (IQR 6–107). 76 participants (95%) with both HIV and NCDs reported direct costs, and 48% reported paying user fees for NCD services. Participants had missed a median of 2 HIV appointments in the past year (IQR 2–3). Higher OOP costs were not associated with the number of HIV appointments missed. 21% of participants reported spending over 10% of household income on HIV and/or NCD care. Discussion and conclusions: Despite the availability of free ART, most participants reported OOP spending. OOP costs were much higher for participants with co-morbid NCDs.