Patient costs of accessing collaborative tuberculosis and human immunodeficiency virus interventions in Ethiopia.

OBJECTIVE: To measure the patient costs of tuberculosis and human immunodeficiency virus (TB-HIV) services from hospital-based pilot sites for collaborative TB-HIV interventions in Ethiopia. METHODS: Costs of pre-treatment and treatment for a range of TB-HIV services provided as part of a collaborative TB-HIV programme in Ethiopia were estimated. RESULTS: Patient costs were found to be substantial compared to income levels. Pre-treatment costs were 35% of annual household income for TB patients (with no HIV), 33% for those with TB and HIV and 40% for those with HIV (with no TB). Pre-treatment direct costs were particularly significant. Patient costs during treatment for TB range between 49% and 71% of annual household income. Patient costs in the first year of antiretroviral treatment were 21% of annual household income. Costs fell as treatment progressed. CONCLUSION: Our results highlight the need to mitigate the economic impact on patients of treatment for TB and HIV/AIDS (acquired immune-deficiency syndrome) in low-income countries. Collaborative TB-HIV services may provide an opportunity to reduce pre-treatment costs by providing an additional channel for the early diagnosis of HIV. Costs may be further reduced by ensuring that diagnostics are provided free of charge, providing social support at the start of treatment and bringing services closer to the patient.