HIV Status Knowledge and Healthcare Utilization in Rural South Africa: An illustrative comparison of HIV and Diabetes in the HAALSI Cohort

Abstract Background Studies from rural South Africa indicate that people living with HIV (PLHIV) may have better health outcomes than those without, potentially due to the frequent healthcare visits necessitated by infection. Here, we examined the association between HIV status and healthcare utilization, using diabetes as an illustrative comparator of another high-burden, healthcare-intensive disease. Methods Our exposure of interest was awareness of positive disease status for both HIV and diabetes. We identified 742 individuals who were HIV-positive and aware of their status and 305 who had diabetes and were aware of their status. Further, HIV status was divided into two groups based on viral suppression. For each disease, we estimated the association with (1) other comorbid, chronic conditions, (2) health facility visits, (3) household-level healthcare expenditure, and (4) per-visit healthcare expenditure. We used log-binomial regression models to estimate prevalence ratios for co-morbid chronic conditions. Linear regression models were used for all other outcomes. Results Virally suppressed PLHIV had decreased prevalence of chronic conditions, increased public clinic visits [β = 0.59, 95% CI: 0.5, 0.7], and reduced per-visit private clinic spending [β = -60, 95% CI: -83, -6] compared to those without HIV. No differences were observed in hospitalizations and per-visit spending at hospitals and public clinics between virally suppressed PLHIV and non-PLHIV. Conversely, diabetic individuals had increased prevalence of chronic conditions, increased visits across facility types, increased household-level expenditures (β = 88 R, 95% CI: 29, 154), per-visit hospital spending (β = 54 R, 95% CI: 7, 155), and per-visit public clinic spending (β = 31 R, 95% CI: 2, 74) compared to those without diabetes. Conclusions Our results suggest that older PLHIV are visiting public clinics more often than their HIV-negative counterparts but are spending similarly on a per-visit basis. This provides evidence that the positive health outcomes observed among PLHIV may be explained by different healthcare engagement patterns. Through our illustrative comparison between PLHIV and diabetic individuals, we provide evidence that shifting disease burdens towards chronic and historically underfunded diseases, like diabetes, may be changing the landscape of health expenditure inequities..

Medienart:	Preprint

Erscheinungsjahr:	2023
Erschienen:	2023

Enthalten in:	ResearchSquare.com - (2023) vom: 13. Nov. Zur Gesamtaufnahme - year:2023

Sprache:	Englisch

Beteiligte Personen:	Beidelman, Erika [VerfasserIn] Bärnighausen, Till [VerfasserIn] Wing, Coady [VerfasserIn] Tollman, Stephen [VerfasserIn] Phillips, Meredith [VerfasserIn] Rosenberg, Molly [VerfasserIn]

Links:	Volltext [lizenzpflichtig] Volltext [kostenfrei]

Themen:	570 Biology

doi:	10.21203/rs.3.rs-2306892/v1

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PPN (Katalog-ID):	XRA038099543