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      Analysis of hospitalization expenses of 610 HIV/AIDS patients in Nantong, China

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          Abstract

          Background

          The goal of this study was to describe the expenses related to human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) management and care in Nantong Infectious Disease Hospital from October 2013 through June 2017.

          Methods

          The information of 610 HIV/AIDS inpatients were collected from the Electronic Medical Record System of the hospital. Univariate and path analysis were employed to evaluate the association between hospitalization expense and its related factors.

          Results

          The average hospitalization expenses per person was 5454 RMB (Renminbi, the currency of China, about $808 USD) and 23,555 RMB (about $3489 USD), respectively for HIV/AIDS patients. The average length of hospital stay was 10.0 ± 5.5 days for HIV patients and 21.7 ± 12.4 days for AIDS patients. For HIV patients, laboratory test fees constituted 37.46% of total expenses; while drug fees accounted for the largest proportion for AIDS patients. Path analysis indicated that the length of hospital stay was the most important factor affecting total expenses (total path coefficient = 0.563 for HIV patients and 0.649 for AIDS patients). Total expenses for HIV-infected females was higher than that of males (total path coefficient = 0.217), and the more complications led to higher expenses for AIDS patients.

          Conclusions

          Though antiretroviral therapy (ART) is provided for free in China, associated medical care, particularly hospitalizations and fees, continue to drive up the medical costs of patients living with HIV and AIDS. Understanding the factors influencing these costs are crucial for determining policies and strategies that can reduce the economic burden of HIV/AIDS patients in China.

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          Most cited references13

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          Prediction of adherence to antiretroviral therapy: a one-year longitudinal study.

          The aim of this longitudinal study was to identify the determinants of adherence to antiretroviral therapy (ART) in HIV patients over a period of 12 months. A total of 376 individuals living with HIV treated with ART participated in the study. Data were collected at baseline and at three, six, nine and 12 months. Variables assessed were adherence, attitude, outcome expectancies, self-efficacy, patient satisfaction with the relationship with their physician, provision of social support, optimism, CD4 cell count, viral load and side effects. Predictors of adherence in the Generalized Estimated Equation (GEE) were: high perception of self-efficacy (OR=1.68; 95%CI 1.27-2.22), positive attitude towards taking medication (OR=1.56; 95%CI 1.18-2.06), not living alone (OR=1.47; 95%CI 1.04-2.08) and being a male (OR=2.81; 95%CI 1.47-5.34). Subsequent analysis showed that a positive attitude towards taking medication was associated with a high level of patient satisfaction with their physician, high perceived social support, being optimistic, living with HIV for five years or less and experiencing no side effects. Also, a strong sense of self-efficacy was associated with positive perception of social support, high level of patient satisfaction with their physician and not living alone. These results suggest that interventions aimed at improving adherence to ART should focus on reinforcing self-efficacy and developing a positive attitude towards taking medication.
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            Antiretroviral Therapy for HIV Infection in 1997

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              The High Cost of HIV-Positive Inpatient Care at an Urban Hospital in Johannesburg, South Africa

              Background While most HIV care is provided on an outpatient basis, hospitals continue to treat serious HIV-related admissions, which is relatively resource-intensive and expensive. This study reports the primary reasons for HIV-related admission at a regional, urban hospital in Johannesburg, South Africa and estimates the associated lengths of stay and costs. Methods and Findings A retrospective cohort study of adult, medical admissions was conducted. Each admission was assigned a reason for admission and an outcome. The length of stay was calculated for all patients (N = 1,041) and for HIV-positive patients (n = 469), actual utilization and associated costs were also estimated. Just under half were known to be HIV-positive admissions. Deaths and transfers were proportionately higher amongst HIV-positive admissions compared to HIV-negative and unknown. The three most common reasons for admission were tuberculosis and other mycobacterial infections (18%, n = 187), cardiovascular disorders (12%, n = 127) and bacterial infections (12%, n = 121). The study sample utilized a total of 7,733 bed days of those, 55% (4,259/7,733) were for HIV-positive patients. The average cost per admission amongst confirmed HIV-positive patients, which was an average of 9.3 days in length, was $1,783 (United States Dollars). Conclusions Even in the era of large-scale antiretroviral treatment, inpatient facilities in South Africa shoulder a significant HIV burden. The majority of this burden is related to patients not on ART (298/469, 64%), and accounts for more than half of all inpatient resources. Reducing the costs of inpatient care is thus another important benefit of expanding access to ART, promoting earlier ART initiation, and achieving rates of ART retention and adherence.
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                Author and article information

                Contributors
                ntqingang@163.com
                zoumeiyin@126.com
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                31 August 2020
                31 August 2020
                2020
                : 20
                : 813
                Affiliations
                [1 ]GRID grid.260483.b, ISNI 0000 0000 9530 8833, Department of Epidemiology and Biostatistics, School of Public Health, , Nantong University, ; Nantong, Jiangsu 226019 People’s Republic of China
                [2 ]Nantong Center for Disease Control and Prevention, Nantong, Jiangsu 226007 People’s Republic of China
                [3 ]GRID grid.198530.6, ISNI 0000 0000 8803 2373, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, ; Beijing, 100872 People’s Republic of China
                [4 ]GRID grid.260483.b, ISNI 0000 0000 9530 8833, Affiliated Infectious Disease Hospital of Nantong University, ; Nantong, Jiangsu 226000 People’s Republic of China
                Author information
                http://orcid.org/0000-0002-0161-4958
                Article
                5687
                10.1186/s12913-020-05687-4
                7460744
                32867780
                588cfae4-48f6-4832-bbac-0ac1a5400d9c
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 12 August 2019
                : 24 August 2020
                Funding
                Funded by: Precision Targeted Intervention Studies among High Risk Groups for HIV Prevention in China, National Science and Technology Major Project
                Award ID: 2018ZX10721102
                Award Recipient :
                Funded by: the key Project of Philosophy and Social Sciences Research in Jiangsu Education Department
                Award ID: 2018SJZDI123
                Award Recipient :
                Funded by: the Nantong Municipal Bureau of Science and Technology
                Award ID: MS12018001
                Award Recipient :
                Funded by: Postgraduate Research & Practice Innovation Program of Jiangsu Province
                Award ID: KYCX18_2432
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Health & Social care
                aids,hiv,hospitalization expense,path analysis
                Health & Social care
                aids, hiv, hospitalization expense, path analysis

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