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Geldsetzer P, Sauer A, Francis JM, Mboggo E, Lwezaula S, Sando D, Fawzi W, Ulenga N, Bärnighausen T. Willingness to pay for community delivery of antiretroviral treatment in urban Tanzania: a cross-sectional survey. Health Policy Plan 2021; 35:1300-1308. [PMID: 33083837 PMCID: PMC7886440 DOI: 10.1093/heapol/czaa088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2020] [Indexed: 11/23/2022] Open
Abstract
Community health worker (CHW)-led community delivery of HIV antiretroviral therapy (ART) could increase ART coverage and decongest healthcare facilities. It is unknown how much patients would be willing to pay to receive ART at home and, thus, whether ART community delivery could be self-financing. Set in Dar es Salaam, this study aimed to determine patients' willingness to pay (WTP) for CHW-led ART community delivery. We sampled ART patients living in the neighbourhoods surrounding each of 48 public-sector healthcare facilities in Dar es Salaam. We asked participants (N = 1799) whether they (1) preferred ART community delivery over standard facility-based care, (2) would be willing to pay for ART community delivery and (3) would be willing to pay each of an incrementally increasing range of prices for the service. 45.0% (810/1799; 95% CI: 42.7-47.3) of participants preferred ART community delivery over standard facility-based care and 51.5% (417/810; 95% CI: 48.1-55.0) of these respondents were willing to pay for ART community delivery. Among those willing to pay, the mean and median amount that participants were willing to pay for one ART community delivery that provides a 2-months' supply of antiretroviral drugs was 3.61 purchasing-power-parity-adjusted dollars (PPP$) (95% CI: 2.96-4.26) and 1.27 PPP$ (IQR: 1.27-2.12), respectively. An important limitation of this study is that participants all resided in neighbourhoods within the catchment area of the healthcare facility at which they were interviewed and, thus, may incur less costs to attend standard facility-based ART care than other ART patients in Dar es Salaam. While there appears to be a substantial WTP, patient payments would only constitute a minority of the costs of implementing ART community delivery. Thus, major co-financing from governments or donors would likely be required.
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Affiliation(s)
- Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305, USA
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Alexander Sauer
- Department of Statistics, University of Oxford, 24-29 St Giles', Oxford OX1 3LB, UK
| | - Joel M Francis
- Department of Family Medicine and Primary Care, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Eric Mboggo
- Management and Development for Health, Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Sharon Lwezaula
- National AIDS Control Program, Lithuli Street, Dar es Salaam, P.O. Box 11857, Tanzania
| | - David Sando
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Nzovu Ulenga
- Management and Development for Health, Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Africa Health Research Institute (AHRI), Africa Centre Building, Via R618 to Hlabisa, Somkhele, P.O. Box 198, Mtubatuba 3935, South Africa
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Thomas T, Samuel-Hodge CD, Porterfield DS, Alva ML, Leeman J. Scaling Up Diabetes Prevention Programs in North Carolina: Perceptions of Demand From Potential Program Recipients and Providers. DIABETES EDUCATOR 2018; 45:116-124. [DOI: 10.1177/0145721718811564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study was to assess factors that influence demand for the Diabetes Prevention Program (DPP) from the perspectives of potential program participants and providers. Methods A qualitative study guided by a conceptual framework was conducted with potential DPP participants and potential DPP providers. Five focus groups with potential participants (n = 37) and key informant interviews with potential providers (n = 14) were conducted in community settings across North Carolina. Results Although providers considered prediabetes to be an important health problem, potential DPP participants expressed less urgency related to a diagnosis of prediabetes. Potential participants felt that they were more likely to adopt diabetes prevention programs if affordable and convenient. For potential program providers, funding, collaboration, and staff support were key considerations for DPP adoption. Providers were supportive of DPP features; however, there was concern from both stakeholders on retention in a 16-week program. Both groups cited transportation, cost, and health insurance reimbursement as existing barriers to the uptake of these programs. Conclusion This qualitative study highlights important considerations for scaling up diabetes prevention programs in community settings, including what constraints agencies face in adopting programs, the perceived demand and programmatic needs for these services by customers, and the need for improving patient education on prediabetes. This implementation science study allows us to increase the potential to scale up and sustain diabetes prevention programs that fit available resources and customer needs.
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Affiliation(s)
- Tainayah Thomas
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carmen D. Samuel-Hodge
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Deborah S. Porterfield
- Department of Family Medicine, School of Medicine, University of North Carolina, RTI International, Chapel Hill and Durham, North Carolina
| | | | - Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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