Health service use and household expenditure during terminal illness due to AIDS in rural Tanzania

Most knowledge about health seeking behaviour during terminal illness among people with HIV/AIDS in Africa is derived from health facility based studies. This study uses data from a longitudinal community study in a rural area in north-west Tanzania, where interviews were conducted on health seeking behaviour and expenditure with relatives who lost an adult family member in recent months. HIV status and verbal autopsy were used to assess if service use differed by cause of death. During terminal illness, people with HIV/AIDS made extensive use of both traditional and modern health services, and more so than people who died from other causes. The main factor associated with this difference was the longer duration of illness. Expenses associated with HIV/AIDS terminal illness were higher than for other causes of death, largely because of the longer duration of illness. The direct medical costs were about 1.5 times higher than the funeral costs and the sum of the medical and funeral costs exceeded the estimated annual household income per capita in this population. In conclusion, the rapid increase in numbers of terminally ill adults as a result of HIV/AIDS is likely to lead to an increased burden on all layers of the health system and household resources, in part because of the relatively long duration of HIV/AIDS terminal illness. However, almost half of all HIV/AIDS deaths in this rural population were not admitted to hospitals during their terminal illness and only a small proportion died in hospitals. If more effective treatment becomes available, a further increase in health service use and direct medical costs to households and community is likely.