Understanding the financial hardships faced by TB and HIV patients during the COVID-19 pandemic: a mixed-method study in Bandung and Yogyakarta, Indonesia
Issued Date
2025-11-12
Resource Type
eISSN
14602237
Scopus ID
2-s2.0-105021470980
Pubmed ID
40926593
Journal Title
Health Policy and Planning
Volume
40
Issue
10
Start Page
1102
End Page
1115
Rights Holder(s)
SCOPUS
Bibliographic Citation
Health Policy and Planning Vol.40 No.10 (2025) , 1102-1115
Suggested Citation
Fardousi N., Negara S.N.S., Subronto Y.W., Mashuri Y.A., Cheng Q., Wulandari L.P.L., Putra I.W.C.S.D., Wahyuningtias S.D., Probandari A., Thabrany H., Wiseman V., Ahmad R.A., Boettiger D., Liverani M. Understanding the financial hardships faced by TB and HIV patients during the COVID-19 pandemic: a mixed-method study in Bandung and Yogyakarta, Indonesia. Health Policy and Planning Vol.40 No.10 (2025) , 1102-1115. 1115. doi:10.1093/heapol/czaf058 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/113150
Title
Understanding the financial hardships faced by TB and HIV patients during the COVID-19 pandemic: a mixed-method study in Bandung and Yogyakarta, Indonesia
Corresponding Author(s)
Other Contributor(s)
Abstract
The COVID-19 pandemic had significant widespread financial impacts, resulting in decreased household income, increased unemployment, and disrupted health services. Despite the higher prevalence of infections of tuberculosis (TB) and human immunodeficiency virus (HIV) in poorer populations, research on the financial challenges faced by these populations during the pandemic is still limited. Indonesia recorded the highest COVID-19 cases in Southeast Asia (6 815 156) while contending with the dual burden of HIV and TB. This study investigates the factors influencing out-of-pocket (OOP) payments and catastrophic health spending during the pandemic, alongside patients' challenges and coping mechanisms in Bandung and Yogyakarta, Indonesia. We employed a parallel convergent mixed-methods approach, combining quantitative analysis of OOP costs with qualitative interviews. The determinants of OOP payments were analysed using a two-part cluster-robust regression model. Catastrophic health spending was defined as OOP payments exceeding 10% of a household's annual income. Data on OOP spending were recorded via diaries, while qualitative data were gathered from in-depth interviews with TB and HIV patients and healthcare workers from January to October 2022. The findings indicated that 5.13% [95% confidence interval (CI): 2.99-7.28] of households incurred catastrophically. The median household spent USD 8.48 OOP, with nonmedical expenses comprising the largest share (median USD 5.93). Key predictors of higher costs included facility location in Yogyakarta (OOP costs difference USD 23.84, 95% CI: 9.90-37.77, P < .001), seeking care from public hospitals (USD 17.37, 95% CI: 8.83-25.90, P < .001), and the absence of health insurance (USD 10.49, 95% CI: 2.40-18.58, P = .011). Patients reported that job losses during lockdowns exacerbated financial strain, while coping strategies documented included borrowing, family contributions, and selling assets. This is the first study to focus on OOP spending and the financial hardships experienced by TB and HIV patients in Indonesia during the pandemic, providing insights for targeted policy and preparedness efforts to alleviate the financial burden during large-scale public health crises.