Volume 46 | Number 6pt2 | December 2011

Abstract List

Sylvie Boyer Ph.D., Mohammad Abu‐Zaineh Ph.D., Jérôme Blanche M.Sc., Sandrine Loubière Ph.D., Renée‐Cécile Bonono M.Sc., Jean‐Paul Moatti Ph.D., Bruno Ventelou Ph.D.


Scaling up antiretroviral treatment () through decentralization of 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 care decentralization has a protective effect against the risk of CHE associated with HIV infection.

Data Source and Study Design

We use primary data from the cross‐sectional 12‐116 survey, conducted in 2006–2007 among a random sample of 3,151 ‐infected outpatients followed up in 27 hospitals in ameroon.

Data Collection and Methods

Data collected contain sociodemographic, economic, and clinical information on patients as well as health care supply‐related characteristics. We assess the determinants of among the ‐treated patients using a hierarchical logistic model ( = 2,412), designed to adequately investigate the separate effects of patients and supply‐related characteristics.

Principal Findings

Expenditures for care exceed 17 percent of household income for 50 percent of the study population. After adjusting for individual characteristics and technological level, decentralization of services emerges as the main health system factor explaining interclass variance, with a protective effect on the risk of .


The findings suggest that HIV care decentralization is likely to enhance equity in access to . Decentralization appears, however, to be a necessary but insufficient condition to fully remove the risk of , unless other innovative reforms in health financing are introduced.