Introduction: With an estimated 1.8 million People Living with HIV (PLHIV), Nigeria’s HIV response is still heavily donor dependent. However, with anticipated decline in donor funding for HIV/AIDS program as the country takes ownership of the program, understanding financing options for PLHIV is important. One of such financing options is affordability of out-of-pocket payments (OOP) for anti-retroviral drugs (ARV) by PLHIV. We assessed affordability of OOP payments for ARVs in Kano State, North-Western Nigeria. Methods: Four Hundred and sixty-nine PLHIV receiving donor-supported-free ARV in Kano, North Western Nigeria were systematically selected and interviewed during routine clinic visits. Affordability for ARV was assessed by a combination of variables including willingness and financial means to incur extra expense for full dose of ARV based on landing and distribution cost of 8.3 USD (about 3,000 NGN) per month dose. Results: Four hundred and sixty-nine respondents were interviewed. Of those, 72 (15.4%, 95% CI: [13.2 - 19.7]) can afford ARV OOP on monthly base. The proportion of males able to pay 3,000 NGN (8.3 USD) or more OOP for ARVs was not different from that of women (15.5% versus 15.2%). Attending school, education level, employment, monthly income and wealth have all been found to be associated with willingness and ability to pay for monthly dose of ARV OOP (p < 0.0001). Conclusion/recommendation: Majority of PLHIV in Kano State may not afford ARV OOP in the event of withdrawal of supports by international donors. Innovative sustainable financing mechanisms from domestic resources are needed for HIV program sustainability.
References
[1]
UNAIDS (2019) AIDS People Living with HIV—All Ages. https://aidsinfo.unaids.org/
[2]
Federal Ministry of Health, Nigeria (2019) Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) 2018: Technical Report. Federal Ministry of Health, Abuja, Nigeria.
[3]
The United States President’s Emergency Plan for AIDS Relief (PEPFAR). https://www.state.gov/pepfar/
[4]
US Embassy and Consulate in Nigeria (2020) PEPFAR. https://ng.usembassy.gov/embassy-consulate/abuja/sections-offices/pepfar/
[5]
Randy, S. and PEPFAR Program (2012) On Costs of Treatment in the President’s Emergency Plan for AIDS Relief (PEPFAR).
[6]
UNAIDS and The Henry J Kaiser Family Foundation (2017) Donor Government Funding for HIV in Low- and Middle-Income Countries in 2016. The Henry J Kaiser Family Foundation, Washington DC.
[7]
Kates, J., Wexler, A., Lief, E. and Joint United Nations Programme on HIV/AIDS (UNAIDS) (2019) Donor-Government-Funding for-HIV in Low and Middle-Income Countries 2019. http://files.kff.org/attachment/Donor-Government-Funding-for-HIV-in-Low-and-Middle-Income-Countries-in-2019.pdf
[8]
Funding for HIV and AIDS (Avert 2021) https://www.avert.org/professionals/hiv-around-world/global-response/funding#footnote14_rdfzzgs
[9]
Reem, H. (2018) Nigeria Health Financing System Assessment. Discussion Paper, World Bank Group, Washington DC. http://documents1.worldbank.org/curated/en/782821529683086336/pdf/127519-WP-PUBLIC-add-series-NigeriaHFSAFINAL.pdf
[10]
Global Burden of Disease Health Financing Collaborator Network (2019) Past, Present, and Future of Global Health Financing: A Review of Development Assistance, Government, Out-of-Pocket, and Other Private Spending on Health for 195 Countries, 1995-2050. The Lancet, 393, 2233-2260. https://doi.org/10.1016/S0140-6736(19)30841-4
[11]
Mcintyre, D., Meheus, F. and Røttingen, J.A. (2017) What Level of Domestic Government Health Expenditure Should We Aspire to for Universal Health Coverage? Health Economics, Policy and Law, 12, 125-137. https://doi.org/10.1017/S1744133116000414
[12]
National Agency for Control of HIV/AIDS (NACA) (2020) NACA Nigeria Unfolds Plan for $150m HIV Trust Fund. https://naca.gov.ng/naca-unfolds-plan-for-150m-hiv-trust-fund/
[13]
Mbachu, C., Okoli, C., Onwujekwe, O., & Enabulele, F. (2018) Willingness to Pay for Antiretroviral Drugs among HIV and AIDS Clients in South-East Nigeria. Health Expectations, 21, 270-278. https://doi.org/10.1111/hex.12612
[14]
Adebimpe, W.O., Badru, N.D., Adeoye, O.A. and Osifo, J. (2020) Willingness of People Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome to Pay for Treatment and Preventive Services in Human Immunodeficiency Virus Care Centers in Osogbo, Osun State. Medical Journal of Babylon, 17, 84-88.
[15]
Varrella, S. (2019) Poverty Headcount Rate in Nigeria as of 2019, by State. https://www.statista.com/statistics/1121438/poverty-headcount-rate-in-nigeria-by-state/
[16]
Nigeria Subnational HIV Estimates (UNAIDS Spectrum Model 2019) Based on NAIIS 2018 Data in: Revised National HIV and AIDS Strategic Framework, 2019-2021. https://naca.gov.ng/wp-content/uploads/2019/03/NATIONAL-HIV-AND-AIDS-STRATEGIC-FRAMEWORK-1.pdf
[17]
PEPFAR Nigeria Annual Program Results (2020) Patients that Are Currently Receiving Antiretroviral Treatment (ART) by State in Nigeria.
[18]
Edward Jackson, J. (1980) Principal Components and Factor Analysis: Part I—Principal Components. Journal of Quality Technology, 12, 201-213. https://doi.org/10.1080/00224065.1980.11980967
[19]
National Population Commission (NPC) [Nigeria] and ICF (2019) Nigeria Demographic and Health Survey 2018. National Population Commission and ICF, Abuja and Rockville. https://dhsprogram.com/pubs/pdf/FR359/FR359.pdf
[20]
Dauda, R.S. (2018) HIV/AIDS and Economic Growth: Evidence from West Africa. The International Journal of Health Planning and Management, 34, 324-337. https://doi.org/10.1002/hpm.2633
[21]
Bunyasi, E. W. and Coetzee, D.J. (2017) Relationship between Socioeconomic Status and HIV Infection: Findings from a Survey in the Free State and Western Cape Provinces of South Africa. BMJ Open, 7, e016232. https://doi.org/10.1136/bmjopen-2017-016232
[22]
Taraphdar, P., Guha, R.T., Haldar, D., Chatterjee, A., Dasgupta, A., Saha, B. and Mallik, S. (2011) Socioeconomic Consequences of HIV/AIDS in the Family System. Nigerian Medical Journal, 52, 250-253.
[23]
Xu, K., Evans, D.B., Kawabata, K., et al. World Health Organizations (WHO, 2003) Household Catastrophic Health Expenditure: A Multi-Country Analysis. The Lancet, 362, 111-117. https://www.who.int/health_financing/documents/lancet-catastrophic_expenditure.pdf
[24]
Ramjee, G. and Daniels, B. (2013) Women and HIV in Sub-Saharan Africa. AIDS Research and Therapy, 10, Article No. 30. https://doi.org/10.1186/1742-6405-10-30
[25]
Chaturaka, R. and Senaka, R. (2010) HIV, Poverty and Women. International Health, 2, 9-16. https://doi.org/10.1016/j.inhe.2009.12.003
[26]
Aasha Kapur, M. and Sreoshi, G. (2005) The Impact of HIV AIDS on Women Care Givers in Situations of Poverty: Policy Issues. https://ssrn.com/abstract=1756789
[27]
Schatz, E., Madhavan, S. and Williams, J. (2011) Female-Headed Households Contending with AIDS-Related Hardship in Rural South Africa. Health & Place, 17, 598-605. https://doi.org/10.1016/j.healthplace.2010.12.017
[28]
Banigbe, B., Audet, C.M., Okonkwo, P., Arije, O.O., Bassi, E., Clouse, K., et al. (2019) Effect of PEPFAR Funding Policy Change on HIV Service Delivery in a Large HIV Care and Treatment Network in Nigeria. PLoS ONE, 14, e0221809. https://doi.org/10.1371/journal.pone.0221809
[29]
Rasschaert, F., Decroo, T., Remartinez, D., Telfer, B., Lessitala, F., Biot, M., et al. (2014) Sustainability of a Community-Based Anti-Retroviral Care Delivery Model—A Qualitative Research Study in Tete, Mozambique. Journal of the International AIDS Society, 17, Article No. 18910. https://doi.org/10.7448/IAS.17.1.18910 http://www.jiasociety.org/index.php/jias/article/view/18910
[30]
Swain, J.D., Pugliese, D.N., Mucumbitsi, J., Rusingiza, E.K., Ruhamya, N., Kagame, A., et al. (2014) Partnership for Sustainability in Cardiac Surgery to Address Critical Rheumatic Heart Disease in Sub-Saharan Africa: The Experience from Rwanda. World Journal of Surgery, 38, 2205-2211. https://doi.org/10.1007/s00268-014-2559-2
[31]
Torpey, K., Mwenda, L., Thompson, C., Wamuwi, E. and van Damme, W. (2010) From Project Aid to Sustainable HIV Services: A Case Study from Zambia. Journal of the International AIDS Society, 13, 19. https://doi.org/10.1186/1758-2652-13-19
[32]
Prakongsai, P., Patcharanarumol, W., & Tangcharoensathien, V. (2008) Can Earmarking Mobilize and Sustain Resources to the Health Sector? Bulletin of the World Health Organization, 86, 898-901. https://doi.org/10.2471/BLT.07.049593
[33]
Onoka, C.A., Onwujekwe, O.E., Uzochukwu, B.S. and Ezumah, N.N. (2013) Promoting Universal Financial Protection: Constraints and Enabling Factors in Scaling-up Coverage with Social Health Insurance in Nigeria. Health Research Policy and Systems, 11, Article No. 20. https://doi.org/10.1186/1478-4505-11-20
[34]
McIntyre, D., Ranson, M.K., Aulakh, B.K. and Honda, A. (2013) Promoting Universal Financial Protection: Evidence from Seven Low- and Middle-Income Countries on Factors Facilitating or Hindering Progress. Health Research Policy and Systems, 11, Article No. 36. https://doi.org/10.1186/1478-4505-11-36
[35]
Okebukola, P.O. and Brieger, W.R. (2016) Providing Universal Health Insurance Coverage in Nigeria. International Quarterly of Community Health Education, 36, 241-246. https://doi.org/10.1177%2F0272684X16657451
[36]
Varrella, S. (2020) Health Insurance Coverage in Nigeria in 2018, by Type and Gender. https://www.statista.com/statistics/1124773/health-insurance-coverage-in-nigeria-by-type-and-gender/
[37]
Katz, I., Routh, S., Bitran, R., Hulme, A. and Avila, C. (2014) Where Will the Money Come from? Alternative Mechanisms to HIV Donor Funding. BMC Public Health, 14, Article No. 956. https://doi.org/10.1186/1471-2458-14-956
[38]
Zakumumpa, H., Bennett, S. and Ssengooba, F. (2019) Leveraging the Lessons Learned from Financing HIV Programs to Advance the Universal Health Coverage (UHC) Agenda in the East African Community. Glob Health Res Policy, 4, Article No. 27. https://doi.org/10.1186/s41256-019-0118-y
[39]
Sanusi, A., Abdulazeez, A., Zubaida, F., Gadanya, M. and Lawal Jimoh, M. (2018) Prevalence and Pattern of Unintentional Domestic Accidents and Trauma amongst Children Attending Public Hospitals in Kano, Nigeria. Sahel Medical Journal, 21, 6-12. http://doi.org/10.4103/1118-8561.232787
[40]
Wirtz, V.J., Forsythe, S.S., Valencia-Mendoza, A., Bautista-Arredondo, S. and Santa Ana-Téllez, Y. (2008) The Cost of Antiretrovirals; Maximizing Value for Money. Draft Working Paper (AIDS 2031). Results for Development Institute, Washington DC. https://r4d.org/wp-content/uploads/The-Cost-of-Antiretrovirals.pdf
[41]
Tagar, E., Sundaram, M., Condliffe, K., Matatiyo, B., Chimbwandira, F., Chilima, B., et al. (2014) Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia. PLoS ONE, 9, e108304. https://doi.org/10.1371/journal.pone.0108304
[42]
USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM, 2021) Country Approach—Nigeria. https://www.ghsupplychain.org/country-profile/nigeria
