Study analyses health costs for people living with both HIV and depression, highlight changes needed to HIV care and health policies in Uganda
New research from the London School of Hygiene & Tropical Medicine highlights the need for better healthcare coverage and social protection policies for people living with depression alongside HIV.
Published in Health Policy and Planning, the findings show the economic burden that depression creates for people living with HIV in Uganda. This burden includes healthcare costs beyond what is free at the point of use, as well as the cost of travel and food to attend care, and the value of lost wages or time.
Estimates suggest that potentially up to 29% of people living with HIV in sub-Saharan Africa have been diagnosed with depressive disorder, as it has become a growing issue in recent decades. Effective HIV treatments have led to a greater need for long-term, chronic care to support those living with HIV for the rest of their lives.
To understand the burden of these conditions on people’s finances, the authors conducted economic analyses of over 1,000 people living with both HIV and depression in Uganda. This was undertaken alongside a recent randomised controlled trial of a depression-integrated model for adult HIV care in Uganda. Their analyses found that people living with both HIV and depression experienced a monthly economic burden of USD$ 5.05 on average.
Out-of-pocket costs are payments made with a patient’s own money rather than insurance or the country’s healthcare system. About half the sample reported no costs at all; amongst the 44% who did bear costs, out-of-pocket costs were $7.22 per month on average. This represents 4% of the average monthly household income in Uganda. This average falls to $3.11 per month when the people with zero costs are included.
Some participants reported that additional payments were for direct medical costs like bed charges. However, the largest contributor to out-of-pocket costs was for travel to attend care. When lost wages or time (due to medical visits or otherwise being unable to work) are included as part of the overall economic burden, this becomes the largest contributor.
Ian Ross, Associate Professor in Health Economics at LSHTM, said: “4% of average income may not seem like a large amount, but it can make a huge difference to people’s lives, especially since people with HIV are likely to have incomes below the average.”
Worry about extra healthcare costs can cause people to delay treatment for as long as possible, even if they suspect depression, which can worsen depression and increase costs and health problems later. These problems are exacerbated by stigma surrounding mental health from family and local communities.
Depression can also make people less likely to adhere to HIV medication. Some of these health problems could be reduced by integrating some guidance around depression into HIV care.
People who struggled to make payments often went to family and friends for financial support to avoid the strict payment schedule and high interest rates of banks. Other public health studies have noted that people sometimes sell assets or borrow at high interest rates to cover healthcare costs.
Eugene Kinyanda, Professor of Mental Health at LSHTM, said: “While HIV treatment is free in Uganda, patients battling both HIV and depression are still burdened by the high costs of transport, food, and lost wages. By expanding financial protections to cover mental healthcare and integrating early support into community-based HIV programs, we can reduce this out-of-pocket expense and improve long-term health outcomes.
“As external funding declines, community-led models such as Community Client-Led ART Delivery (CCLAD) groups can play an especially important role in sustaining HIV services, improving mental health support, and reducing costs for patients.”
As treatments have increased life expectancy for those living with HIV, expanded coverage is more important than ever to meet long-term healthcare needs.
Publication
Katana P, et al. Economic burden of depressive disorders and HIV for people living with HIV in Uganda. Health Policy and Planning, 2026. DOI: https://doi.org/10.1093/heapol/czag054