Healthcare Costs and Financial Barriers to Diagnosis and Treatment of People Living with HIV-Associated Kaposi’s Sarcoma in Western Kenya: A Qualitative Analysis

Rhea Sing; Sigrid Collier; Aggrey Semeere; Helen Byakwaga; Miriam Laker-Oketta; Devon E McMahon; Linda Chemtai; Merridy Grant; Lisa M Butler; Ingrid V Bassett; Samson Kiprono; Toby Maurer; Jeffrey Martin; Naftali Busakhala; Esther E Freeman

doi:10.53876/001c.36143

Background

Financial barriers and high healthcare costs impede early diagnosis and treatment for various cancers. In low-resource settings, financial barriers may be amplified for people living with HIV-associated malignancies, such as Kaposi’s Sarcoma (KS). KS remains prevalent with high mortality in sub–Saharan Africa; understanding the role of financial barriers in this context is an important step toward ensuring timely diagnosis and treatment.

Methods

Eighty-eight semi-structured interviews were conducted using a purposive sample of adults newly diagnosed with HIV-associated KS in western Kenya. Interviews were coded using framework analysis based on the grounded model of help-seeking behavior.

Results

In the 88 semi-structured interviews, lack of financial support and high healthcare costs were described as prominent barriers for diagnosis and treatment of KS (Table 1). We grouped these into eight major categories, with the most prominent themes being lack of financial support, high healthcare costs, getting fired, no insurance knowledge, and having to support one’s family. Lack of financial support from an individual’s friends and family was a commonly cited barrier to attending appointments and obtaining medications. Some individuals had no knowledge of insurance policies such as the National Hospital Insurance Fund (NHIF) of Kenya or were not eligible, thus requiring out of pocket payment for healthcare expenses. The high healthcare costs for chemotherapy were expressed as a major deterrent in many interviews. Some participants reported paying 40,000 shillings (approx. 350 USD) for one “chemotherapy injection.” For those who had to support families during KS treatment, many noted being unable to afford treatment.

Conclusion

Assessing financial barriers for people living with HIV-associated KS is a crucial step in creating the interventions necessary to promote early diagnosis and efficient treatment in this population. Future studies should aim to understand whether health insurance coverage can overcome the financial barriers to diagnosis and treatment of KS.