Understanding the financial hardships faced by TB and HIV patients during the COVID-19 pandemic: A mixed-method study in Bandung and Yogyakarta, Indonesia.

Publication date: Sep 10, 2025

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% CI: 2. 99 to 7. 28) of households incurred catastrophically. The median household spent USD 8. 48 OOP, with non-medical 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 to 37. 77, P

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