Household economic burden of managing people living with HIV and comorbidities of hypertension and diabetes in La Nkwantanang-Madina Municipality, Ghana.

Abstract

Managing HIV alongside chronic conditions such as hypertension and diabetes present significant economic challenges for households, especially in low-and middle-income countries. These chronic diseases not only reduce the quality of life of people living with HIV (PLHIV) but also further increase their economic burden. This study seeks to examine the economic burden of managing PLHIV with hypertension and diabetes comorbidities. The cross-sectional cost-of-illness study used quantitative data gathered from 56 PLHIV with hypertension and/or diabetes receiving ART at two Polyclinics and the Pentecost Hospital in the La Nkwantanang-Madina Municipality. A structured questionnaire was used to collect data on patients' socio-demographic characteristics, direct, indirect, and intangible costs between September to December 2023. Data was analyzed and presented descriptively.The total economic cost of PLHIV managing comorbidities was GHS11,892.11 (USD 1,022.54) with a direct cost of GHS10,739.00 (US$ 923.39) accounting for 90.3% and indirect cost of GHS 1,153.14 (US$ 99.15) accounting for 9.7% over 6 months. Direct medical costs constituted 83.1% of total costs with the cost of medicines being the largest cost component. There was a significant difference between the total costs across the comorbidities (X2=8.58, p = 0.0137). Approximately 45.24% of the average annual income per person was spent on managing comorbidities in PLHIV. About 89% of participants reported a low intangible cost burden. This study reveals the significant economic burden on households managing HIV with hypertension and diabetes comorbidities. Direct costs driven by medication expenses constituted the majority of the burden, while productivity losses compounded indirect costs. Despite widespread health insurance coverage, substantial out-of-pocket payments are made in the management of these comorbidities. The findings emphasize the need for integrated healthcare strategies to address both communicable and non-communicable diseases, especially in low-income settings, and policies to reduce financial barriers. Studies should explore long-term burden and strategies to alleviate the economic impact on vulnerable populations.