Time and money: the cost of utilizing HIV and TB treatment and care in rural KwaZulu-Natal (poster #MOPDE0201) Setting Hlabisa HIV Treatment and Care Programme - a partnership between the Department of Health and the Africa Centre for Health and Population Studies, provides free-of-charge HIV and TB services in primary healthcare clinics in Hlabisa sub-district Methods Two cross-sectional studies and 2010 Probability-proportional-to-size sampling 300 patients on antiretroviral treatment (ART), 200 pre-ART, 300 receiving TB treatment - exclusive groups Data on self-reported - time, financial healthcare expenditures and financial distress indicators (borrowing money and/or selling assets) due to healthcare expenditure

Main findings A third of people reported borrowing money to pay for healthcare in the past four weeks but less than 10% needed to sell assets Financial distress was higher in TB (41%) and ART (39%) patients than pre-ART (31%) patients 1USD is approximately equivalent to 8 South African Rands (ZAR) Pre-ART patients spent more on other healthcare services and self-care than ART and TB patients (163 ZAR pre-ART; 117 ZAR ART; 90 ZAR TB) Transport cost was the largest per clinic visit cost expenditure in all three groups Every additional 10 ZAR spent on the clinic visit increased the odds of financial distress by 51% for pre-ART, 4% for ART and 9% for TB patients Every additional 10 ZAR spent on utilizing other healthcare services increased the odds of financial distress by about 3% in all groups Each additional hour spent at the clinic significantly increased the odds of financial distress by 21% for ART and 64% for TB patients but by 8% in pre-ART patients which was non-significant

Conclusions Despite HIV and TB treatment being free, most patients faced a high financial burden due to healthcare expenditures in this area with high unemployment Higher expenditure amongst pre-ART patients utilizing other healthcare services could indicate a change in health-seeking behaviour once a patient is initiated onto treatment A relatively small expenditure in utilizing healthcare can translate to financial distress in a poor community that relies mainly on temporary state grants of between ZAR [approx USD] per month Financial distress due to healthcare utilization may lead to reduced ART and TB treatment uptake, adherence and retention in care Subsidized transport to public clinics providing free HIV and TB services may help reduce the time and financial burden