Willingness to pay for antiretroviral drugs among HIV and AIDS clients in south-east Nigeria.

Chinyere Mbachu,Obinna Onwujekwe,Chijioke Okoli,Fabian Enabulele

doi:10.1111/hex.12612

Chinyere Mbachu, Obinna Onwujekwe + Show 2 more

Open Access

https://doi.org/10.1111/hex.12612

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Abstract

BackgroundThe current trend of withdrawal of donor support for HIV/AIDS treatment in Nigeria may require that the cost of antiretroviral drugs be borne in part by infected people and their families.ObjectiveThis study was conducted to determine the economic value for free antiretroviral drugs (ARVs) expressed by clients receiving treatment for HIV/AIDS in a tertiary hospital.Study methodThe contingent valuation method was used to elicit the values attached to free ARVs from people living with HIV/AIDS that were receiving care in a public tertiary hospital in south‐east Nigeria. Exit poll using a pre‐tested questionnaire was undertaken with adult clients on treatment. The bidding game technique was used to elicit their willingness to pay (WTP) for ARVs for themselves and members of their households. Ordinary least squares (OLS) multiple regression analysis was used to test the construct validity of elicited WTP amounts.ResultsAbout a third of the respondents were willing to pay for a monthly supply of ARVs for themselves and household members. The mean WTP for monthly supply of ARVs for self was US$15.32 and for household member was US$15.26 (1US$=₦160). OLS regression analysis showed that employment status and higher socio‐economic status were positively associated with higher WTP. OLS showed that age and transport cost per clinic visit were negatively related to WTP. Knowing the risks of not adhering to treatment protocol was positively related to WTP.ConclusionThe respondents positively valued the free ARVs. This calls for greater financial support for the sustainable provision of the treatment service. However, holistic financing mechanisms should be explored to ensure sustained funding in the event of complete withdrawal of donor support.

Highlights

Africa bears the highest burden of HIV infections and HIV/AIDS related mortality in the world.[1]
Over 90% of our participants knew the cost of antiretroviral drugs (ARVs) for HIV/AIDS, their maximum mean willingness to pay (WTP) for a monthly supply of these drugs was less than half of the actual cost of the drugs, implying that knowledge of the cost of ARVs does not necessarily translate into WTP, rather WTP is subject to socio-economic status of participants
Their mean WTP for a monthly supply of ARVs for HIV/AIDS falls below the estimated cost of the drugs

Summary

Introduction

Africa bears the highest burden of HIV infections and HIV/AIDS related mortality in the world.[1] HIV/AIDS is one of the most challenging health problems for policymakers in sub-Saharan Africa.[2] It poses a major threat to the economic viability of infected individuals and invariably reduces household income.[3,4,5] Prevention and treatment of HIV/AIDS have, until recently, been driven solely by development partners and donor agencies, the provision of antiretroviral drugs (ARVs).[2,6,7] Nigeria operates a decentralized health system that is largely financed through tax-based revenue and out- of-pocket spending.[8,9] Health-care services in Nigeria are provided by a multiplicity of health-care providers in the public and private sectors and access and utilization varies across socio-economic and geopolitical subpopulation groups.[10] Current estimates show that about one-third of HIV-infected people are on treatment with ART.[11] HIV drugs are provided free of charge to clients through public and mission hospitals that offer at least secondary level of care. Holistic financing mechanisms should be explored to ensure sustained funding in the event of complete withdrawal of donor support

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