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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Does HIV Services Decentralization Protect against the Risk of Catastrophic Health Expenditures? Some Lessons from Cameroon</title><author><name sortKey="Boyer, Sylvie" sort="Boyer, Sylvie" uniqKey="Boyer S" first="Sylvie" last="Boyer">Sylvie Boyer</name><affiliation><nlm:aff id="au1"></nlm:aff></affiliation><affiliation><nlm:aff id="au2"></nlm:aff></affiliation></author><author><name sortKey="Abu Zaineh, Mohammad" sort="Abu Zaineh, Mohammad" uniqKey="Abu Zaineh M" first="Mohammad" last="Abu-Zaineh">Mohammad Abu-Zaineh</name><affiliation><nlm:aff id="au2"></nlm:aff></affiliation></author><author><name sortKey="Blanche, Jerome" sort="Blanche, Jerome" uniqKey="Blanche J" first="Jérôme" last="Blanche">Jérôme Blanche</name><affiliation><nlm:aff id="au2"></nlm:aff></affiliation></author><author><name sortKey="Loubiere, Sandrine" sort="Loubiere, Sandrine" uniqKey="Loubiere S" first="Sandrine" last="Loubière">Sandrine Loubière</name><affiliation><nlm:aff id="au2"></nlm:aff></affiliation></author><author><name sortKey="Bonono, Renee Cecile" sort="Bonono, Renee Cecile" uniqKey="Bonono R" first="Renée-Cécile" last="Bonono">Renée-Cécile Bonono</name><affiliation><nlm:aff id="au3"></nlm:aff></affiliation></author><author><name sortKey="Moatti, Jean Paul" sort="Moatti, Jean Paul" uniqKey="Moatti J" first="Jean-Paul" last="Moatti">Jean-Paul Moatti</name><affiliation><nlm:aff id="au4"></nlm:aff></affiliation></author><author><name sortKey="Ventelou, Bruno" sort="Ventelou, Bruno" uniqKey="Ventelou B" first="Bruno" last="Ventelou">Bruno Ventelou</name><affiliation><nlm:aff id="au5"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22092226</idno><idno type="pmc">3392995</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392995</idno><idno type="RBID">PMC:3392995</idno><idno type="doi">10.1111/j.1475-6773.2011.01312.x</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">001679</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001679</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Does HIV Services Decentralization Protect against the Risk of Catastrophic Health Expenditures? Some Lessons from Cameroon</title><author><name sortKey="Boyer, Sylvie" sort="Boyer, Sylvie" uniqKey="Boyer S" first="Sylvie" last="Boyer">Sylvie Boyer</name><affiliation><nlm:aff id="au1"></nlm:aff></affiliation><affiliation><nlm:aff id="au2"></nlm:aff></affiliation></author><author><name sortKey="Abu Zaineh, Mohammad" sort="Abu Zaineh, Mohammad" uniqKey="Abu Zaineh M" first="Mohammad" last="Abu-Zaineh">Mohammad Abu-Zaineh</name><affiliation><nlm:aff id="au2"></nlm:aff></affiliation></author><author><name sortKey="Blanche, Jerome" sort="Blanche, Jerome" uniqKey="Blanche J" first="Jérôme" last="Blanche">Jérôme Blanche</name><affiliation><nlm:aff id="au2"></nlm:aff></affiliation></author><author><name sortKey="Loubiere, Sandrine" sort="Loubiere, Sandrine" uniqKey="Loubiere S" first="Sandrine" last="Loubière">Sandrine Loubière</name><affiliation><nlm:aff id="au2"></nlm:aff></affiliation></author><author><name sortKey="Bonono, Renee Cecile" sort="Bonono, Renee Cecile" uniqKey="Bonono R" first="Renée-Cécile" last="Bonono">Renée-Cécile Bonono</name><affiliation><nlm:aff id="au3"></nlm:aff></affiliation></author><author><name sortKey="Moatti, Jean Paul" sort="Moatti, Jean Paul" uniqKey="Moatti J" first="Jean-Paul" last="Moatti">Jean-Paul Moatti</name><affiliation><nlm:aff id="au4"></nlm:aff></affiliation></author><author><name sortKey="Ventelou, Bruno" sort="Ventelou, Bruno" uniqKey="Ventelou B" first="Bruno" last="Ventelou">Bruno Ventelou</name><affiliation><nlm:aff id="au5"></nlm:aff></affiliation></author></analytic><series><title level="j">Health Services Research</title><idno type="ISSN">0017-9124</idno><idno type="eISSN">1475-6773</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>Scaling up antiretroviral treatment (ART) through decentralization of HIV care is increasingly recommended as a strategy toward ensuring equitable access to treatment. However, there have been hitherto few attempts to empirically examine the performance of this policy, and particularly its role in protecting against the risk of catastrophic health expenditures (CHE). This article therefore seeks to assess whether HIV care decentralization has a protective effect against the risk of CHE associated with HIV infection.</p></sec><sec><title>Data Source and Study Design</title><p>We use primary data from the cross-sectional EVAL-ANRS 12-116 survey, conducted in 2006–2007 among a random sample of 3,151 HIV-infected outpatients followed up in 27 hospitals in Cameroon.</p></sec><sec><title>Data Collection and Methods</title><p>Data collected contain sociodemographic, economic, and clinical information on patients as well as health care supply-related characteristics. We assess the determinants of CHE among the ART-treated patients using a hierarchical logistic model (<italic>n</italic> = 2,412), designed to adequately investigate the separate effects of patients and supply-related characteristics.</p></sec><sec><title>Principal Findings</title><p>Expenditures for HIV care exceed 17 percent of household income for 50 percent of the study population. After adjusting for individual characteristics and technological level, decentralization of HIV services emerges as the main health system factor explaining interclass variance, with a protective effect on the risk of CHE.</p></sec><sec><title>Conclusion</title><p>The findings suggest that HIV care decentralization is likely to enhance equity in access to ART. Decentralization appears, however, to be a necessary but insufficient condition to fully remove the risk of CHE, unless other innovative reforms in health financing are introduced.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Health Serv Res</journal-id><journal-id journal-id-type="iso-abbrev">Health Serv Res</journal-id><journal-id journal-id-type="publisher-id">hesr</journal-id><journal-title-group><journal-title>Health Services Research</journal-title></journal-title-group><issn pub-type="ppub">0017-9124</issn><issn pub-type="epub">1475-6773</issn><publisher><publisher-name>Blackwell Science Inc</publisher-name><publisher-loc>Malden, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22092226</article-id><article-id pub-id-type="pmc">3392995</article-id><article-id pub-id-type="doi">10.1111/j.1475-6773.2011.01312.x</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Articles</subject></subj-group></article-categories><title-group><article-title>Does HIV Services Decentralization Protect against the Risk of Catastrophic Health Expenditures? Some Lessons from Cameroon</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Boyer</surname><given-names>Sylvie</given-names></name><degrees>Ph.D.</degrees><xref ref-type="aff" rid="au1">1</xref><xref ref-type="aff" rid="au2">2</xref></contrib><contrib contrib-type="author"><name><surname>Abu-Zaineh</surname><given-names>Mohammad</given-names></name><degrees>Ph.D.</degrees><xref ref-type="aff" rid="au2">2</xref></contrib><contrib contrib-type="author"><name><surname>Blanche</surname><given-names>Jérôme</given-names></name><degrees>M.Sc.</degrees><xref ref-type="aff" rid="au2">2</xref></contrib><contrib contrib-type="author"><name><surname>Loubière</surname><given-names>Sandrine</given-names></name><degrees>Ph.D.</degrees><xref ref-type="aff" rid="au2">2</xref></contrib><contrib contrib-type="author"><name><surname>Bonono</surname><given-names>Renée-Cécile</given-names></name><degrees>M.Sc.</degrees><xref ref-type="aff" rid="au3">3</xref></contrib><contrib contrib-type="author"><name><surname>Moatti</surname><given-names>Jean-Paul</given-names></name><degrees>Ph.D.</degrees><xref ref-type="aff" rid="au4">4</xref></contrib><contrib contrib-type="author"><name><surname>Ventelou</surname><given-names>Bruno</given-names></name><degrees>Ph.D.</degrees><xref ref-type="aff" rid="au5">5</xref></contrib><aff id="au1"><institution>INSERM UMR 912/ORS PACA</institution><addr-line>23 rue Stanislas Torrents, 13006 Marseille, France</addr-line></aff><aff id="au2"><institution>INSERM, U912 (SE4S), Marseille, France and the Université Aix Marseille, IRD, UMRS912, Marseille, France and ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur</institution><addr-line>Marseille, France</addr-line></aff><aff id="au3"><institution>Socio-Anthropological Research Institute (IRSA), Catholic University of Central African States</institution><addr-line>Yaoundé, Cameroon</addr-line></aff><aff id="au4"><institution>INSERM, U912 (SE4S) Marseille, France and, Université Aix Marseille, IRD, UMR-S912, Marseille, France and ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur</institution><addr-line>Marseille, France</addr-line></aff><aff id="au5"><institution>INSERM, U912 (SE4S), Marseille, France, and Université Aix Marseille, IRD, UMR-S912, Marseille, France, and ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, and GRECAM</institution><addr-line>CNRS, Marseille, France</addr-line></aff></contrib-group><author-notes><corresp id="cor1">Address correspondence to Sylvie Boyer, Ph.D., INSERM UMR 912/ORS PACA, 23 rue Stanislas Torrents, 13006 Marseille, France; e-mail: <email>sylvie.boyer@inserm.fr</email>. Sylvie Boyer, Ph.D., Mohammad Abu Zaineh, Ph.D., Jérôme Blanche, M.Sc., and Sandrine Loubière, Ph.D., are with the INSERM, U912 (SE4S), Marseille, France and the Université Aix Marseille, IRD, UMRS912, Marseille, France and ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France. Renée-Cécile Bonono, M.Sc., is with the Socio-Anthropological Research Institute (IRSA), Catholic University of Central African States, Yaoundé, Cameroon. Jean-Paul Moatti, Ph.D., is with the INSERM, U912 (SE4S) Marseille, France and, Université Aix Marseille, IRD, UMR-S912, Marseille, France and ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France. Bruno Ventelou, Ph.D., is with the INSERM, U912 (SE4S), Marseille, France, and Université Aix Marseille, IRD, UMR-S912, Marseille, France, and ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, andGRECAM, CNRS, Marseille, France.</corresp><fn><p>[Corrections made after online publication 9/26/11: The equation at the bottom of page 12 of this article was incorrectly formatted upon publication. This has been corrected.]</p></fn></author-notes><pub-date pub-type="ppub"><month>12</month><year>2011</year></pub-date><volume>46</volume><issue>6 Pt 2</issue><fpage>2029</fpage><lpage>2056</lpage><permissions><copyright-statement>© Health Research and Educational Trust</copyright-statement></permissions><abstract><sec><title>Objective</title><p>Scaling up antiretroviral treatment (ART) through decentralization of HIV care is increasingly recommended as a strategy toward ensuring equitable access to treatment. However, there have been hitherto few attempts to empirically examine the performance of this policy, and particularly its role in protecting against the risk of catastrophic health expenditures (CHE). This article therefore seeks to assess whether HIV care decentralization has a protective effect against the risk of CHE associated with HIV infection.</p></sec><sec><title>Data Source and Study Design</title><p>We use primary data from the cross-sectional EVAL-ANRS 12-116 survey, conducted in 2006–2007 among a random sample of 3,151 HIV-infected outpatients followed up in 27 hospitals in Cameroon.</p></sec><sec><title>Data Collection and Methods</title><p>Data collected contain sociodemographic, economic, and clinical information on patients as well as health care supply-related characteristics. We assess the determinants of CHE among the ART-treated patients using a hierarchical logistic model (<italic>n</italic> = 2,412), designed to adequately investigate the separate effects of patients and supply-related characteristics.</p></sec><sec><title>Principal Findings</title><p>Expenditures for HIV care exceed 17 percent of household income for 50 percent of the study population. After adjusting for individual characteristics and technological level, decentralization of HIV services emerges as the main health system factor explaining interclass variance, with a protective effect on the risk of CHE.</p></sec><sec><title>Conclusion</title><p>The findings suggest that HIV care decentralization is likely to enhance equity in access to ART. Decentralization appears, however, to be a necessary but insufficient condition to fully remove the risk of CHE, unless other innovative reforms in health financing are introduced.</p></sec></abstract><kwd-group><kwd>Catastrophic health expenditures</kwd><kwd>decentralization</kwd><kwd>multilevel modeling</kwd><kwd>HIV treatment</kwd><kwd>Cameroon</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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