{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T10:46:19Z","timestamp":1778755579315,"version":"3.51.4"},"reference-count":34,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,3,19]],"date-time":"2013-03-19T00:00:00Z","timestamp":1363651200000},"content-version":"vor","delay-in-days":77,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"funder":[{"DOI":"10.13039\/501100000226","name":"Ontario Ministry of Health and Long-Term Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000226","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of the International AIDS Society"],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The decentralization of HIV services has been shown to improve equity in access to care for the rural poor of sub\u2010Saharan Africa. This study aims to contribute to our understanding of the impact of decentralization on costs borne by patients. Such information is valuable for economic evaluations of anti\u2010retroviral therapy programmes that take a societal perspective. We compared costs reported by patients who received care in an urban centralized programme to those in the same district who received care through rural decentralized care (DC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross\u2010sectional survey on patient characteristics and costs associated with accessing HIV care was conducted, in May 2010, on 120 patients in centralized care (CC) at a tertiary referral hospital and 120 patients in DC at five rural health centres in Zomba District, Malawi. Differences in costs borne by each group were compared using \u03c7<jats:sup>2<\/jats:sup> and <jats:italic>t<\/jats:italic>\u2010tests, and a regression model was developed to adjust for confounders, using bootstrapping to address skewed cost data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was no significant difference between the groups with respect to sex and age. However, there were significant differences in socio\u2010economic status, with higher educational attainment (<jats:italic>p<\/jats:italic>&lt;0.001), personal income (<jats:italic>p<\/jats:italic>=0.007) and household income per person (<jats:italic>p<\/jats:italic>=0.005) in CC. Travel times were similar (<jats:italic>p<\/jats:italic>=0.65), as was time waiting at the clinic (<jats:italic>p<\/jats:italic>=0.63) and total time spent seeking care (<jats:italic>p<\/jats:italic>=0.65). There was a significant difference in travel\u2010related expenses (<jats:italic>p<\/jats:italic>&lt;0.001) related to the type of travel participants noted that they used. In CC, 60% of participants reported using a mini\u2010bus to reach the clinic; in DC only 4% reported using a mini\u2010bus, and the remainder reported travelling on foot or by bicycle. There were no significant differences between the groups in the amount of lost income reported or other out\u2010of\u2010pocket costs. Approximately 91 Malawi Kwacha (95% confidence intervals: 1\u2013182 MKW) or US$0.59 represents the adjusted difference in total costs per visit between CC and DC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Even within a system of HIV\/AIDS care where patients do not pay to see clinicians or for most medications, they still incur costs. We found that most costs are travel related. This has important implications for poorer patients who live at a distance from health facilities for whom these costs may be significant.<\/jats:p><\/jats:sec>","DOI":"10.7448\/ias.16.1.18055","type":"journal-article","created":{"date-parts":[[2013,3,19]],"date-time":"2013-03-19T09:38:49Z","timestamp":1363685929000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Patient costs associated with accessing HIV\/AIDS care in Malawi"],"prefix":"10.1002","volume":"16","author":[{"given":"Andrew D","family":"Pinto","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monique","family":"van Lettow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beth","family":"Rachlis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrienne K","family":"Chan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumeet K","family":"Sodhi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,3,19]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Report on the global AIDS epidemic","author":"UNAIDS","year":"2008"},{"key":"e_1_2_9_3_1","volume-title":"Together we will end AIDS","author":"UNAIDS","year":"2012"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61546-4"},{"key":"e_1_2_9_5_1","volume-title":"2010 Malawi Demographic and Health Survey (MDHS) HIV Prevalence","author":"Government of Malawi","year":"2010"},{"key":"e_1_2_9_6_1","volume-title":"Quarterly HIV Programme Report April\u2013June 2011","author":"Government of Malawi","year":"2011"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7475.1163"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68809-0"},{"key":"e_1_2_9_9_1","first-page":"1062","article-title":"Scaling up antiretroviral therapy in Africa: learning from tuberculosis control programmes \u2013 the case of Malawi","volume":"9","author":"Libamba E","year":"2005","journal-title":"Int J Tuberc Lung Dis"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181893ef0"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.05.033688"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2009.02.012"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1758-2652-14-S1-S4"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2010.02503.x"},{"key":"e_1_2_9_15_1","first-page":"1","volume":"20","author":"Johns B","year":"2005","journal-title":"Costs of scaling up health interventions: a systematic review. 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