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High out-of-pocket costs for antiretroviral therapy are linked to more treatment failures among HIV-infected patients in Botswana

A new study indicates that among patients in Botswana, higher median out-of-pocket costs for the initial 30 days of highly active antiretroviral therapy (HAART) ($32) were associated with failure to achieve an undetectable viral load (plasma HIV-1 RNA of less than 400 copies/ml). As scale-up efforts in subSaharan Africa progress, HAART costs should be minimized, suggest the researchers at the University of Pennsylvania Center for Education and Research on Therapeutics.

They retrospectively studied the viral loads of HIV-infected patients at a private medical clinic in Botswana. HIV viral loads and CD4 cell counts (another indicator of HIV disease progression) were routinely measured at the clinic prior to and within 4 to 12 months after patients began HAART. An electronic pharmacy database contained drug prescription and cost information. Of 304 patients studied, 183 (60 percent) achieved an undetectable viral load within 12 months after starting HAART.

Initial out-of-pocket HAART cost was nearly 50 percent higher in those who did not achieve an undetectable viral load (median of $32) than those who did (median of $22). This analysis suggests that higher HAART costs lead to both treatment discontinuation and poorer treatment adherence. The study was supported by the Agency for Healthcare Research and Quality (HS10399).

See "Out-of-pocket costs of HAART limit HIV treatment responses in Botswana's private sector," by Gregory P. Bisson, M.D., Ian Frank, M.D., Robert Gross, M.D., M.S.C.E., and others, in AIDS 20(9), pp. 1333-1336, 2006.

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