Laboratory test availability and user fees in routine HIV care: a global analysis in 42 countries

Abstract Background Laboratory testing is critical for diagnosis and treatment management for people with HIV, but is costly. When HIV resources are constrained, even before recent disruptions in US funding for the global HIV response, user fees have been used for cost recovery. We describe availability and charging of user fees for routine HIV laboratory testing globally. Methods Routine test availability and charging of user fees were examined via an HIV clinic survey conducted September 2020–March 2021; responses reflected clinical practices in 2019. HIV clinics came from 42 low-, middle-, and high-income countries from the International epidemiology Databases to Evaluate AIDS (IeDEA) global research consortium. Results Across 199 clinics, on-site test availability was generally limited, reflecting constraints in routine test availability across health conditions more broadly. Over 90% of clinics did not report charging of user fees. A higher percentage reporting user fees were from middle-income countries and from countries receiving Global Fund or PEPFAR country support, which may reflect settings with ongoing health funding gaps. Conclusions Availability and user fees for essential HIV-related laboratory tests were limited in 2019. Monitoring user fees may provide insights about how national health systems are responding to steep reductions in global donor funding.

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Publication Details

Journal
Health Affairs Scholar
Published
2026-06-13
DOI
https://doi.org/10.1093/haschl/qxag151
Primary Topic
HIV/AIDS Research and Interventions
Type
article
Field-Weighted Citation Impact
0.00
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article

Laboratory test availability and user fees in routine HIV care: a global analysis in 42 countries

Lameck Oteko Diero, Kathleen McGinnis, Ephrem Mensah, Ethel Rambiki et al.
Health Affairs Scholar
HIV/AIDS Research and Interventions
article

Laboratory test availability and user fees in routine HIV care: a global analysis in 42 countries

Lameck Oteko Diero, Kathleen McGinnis, Ephrem Mensah, Ethel Rambiki, Romanee Chaiwarith, Raynell Lang, Lauren C. Zalla, Gabriela Carriquiry, Armel Poda, Nicola van Dongen, Helen Byakwaga, Ronald Moses Galiwango, Ellen Brazier, Oliver Ezechi, April D. Kimmel, Carina César, Aimee Freeman, Francesca Odhiambo, David James Templeton, Jeremy L. Ross, Zhongzhe Pan, Chido Chinogurei, Geoffrey Fatti, Gad Murenzi, Sandra Wagner Cardoso, Marco Tulio Luque, Stephany N. Duda, Henri Chenal, Christella Twizere, Peter Ebasone, Patricia Lelo, Sanjay Pujari
article en

Abstract

Abstract Background Laboratory testing is critical for diagnosis and treatment management for people with HIV, but is costly. When HIV resources are constrained, even before recent disruptions in US funding for the global HIV response, user fees have been used for cost recovery. We describe availability and charging of user fees for routine HIV laboratory testing globally. Methods Routine test availability and charging of user fees were examined via an HIV clinic survey conducted September 2020–March 2021; responses reflected clinical practices in 2019. HIV clinics came from 42 low-, middle-, and high-income countries from the International epidemiology Databases to Evaluate AIDS (IeDEA) global research consortium. Results Across 199 clinics, on-site test availability was generally limited, reflecting constraints in routine test availability across health conditions more broadly. Over 90% of clinics did not report charging of user fees. A higher percentage reporting user fees were from middle-income countries and from countries receiving Global Fund or PEPFAR country support, which may reflect settings with ongoing health funding gaps. Conclusions Availability and user fees for essential HIV-related laboratory tests were limited in 2019. Monitoring user fees may provide insights about how national health systems are responding to steep reductions in global donor funding.

Health Affairs Scholar
Western Cape Department of Health (ZA), Mbarara University of Science and Technology (UG), Johns Hopkins University (US), Moi University (KE), University of Cape Town (ZA), University of Calgary (CA), Virginia Commonwealth University (US), Universidad Peruana Cayetano Heredia (PE), Stellenbosch University (ZA), Asia Foundation (US), Kinshasa General Hospital (CD), American Foundation for AIDS Research (US), Kenya Medical Research Institute (KE), University of Kigali (RW), Institute for Family Health (US), VA Connecticut Healthcare System (US), Institut Universitaire d'Abidjan (CI), Espoir Vie-Togo (TG), Lighthouse Trust (MW), Sydney Sexual Health Centre (AU), Instituto de Medicina Tropical (PY), Fundación Huésped (AR), Office of Infectious Diseases (US), Laboratoire National de Référence (MA), Rakai Health Sciences Program (UG), Light University of Bujumbur (BI), Société de Développement des Forêts (CI), Mother Hospital (IN), Sydney Local Health District (AU), West African Health Organisation (BF), Instituto Ecuatoriano de Enfermedades Digestivas (EC), Chiang Mai University (TH), Nigerian Institute of Medical Research (NG), Vanderbilt University Medical Center (US)
Openalex Percentile: Top 6%
HIV/AIDS Research and Interventions
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