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ORIGINAL ARTICLES
Open Access

Sustainability of Funding for HIV Treatment Services: A Cross-Sectional Survey of Patients' Willingness to Pay for Treatment Services in Nigeria

Olawale Durosinmi-Etti, Bruce Fried, Karine Dubé, Sean Sylvia, Sandra Greene, Akudo Ikpeazu and Emmanuel Kelechi Nwala
Global Health: Science and Practice April 2022, 10(2):e2100550; https://doi.org/10.9745/GHSP-D-21-00550
Olawale Durosinmi-Etti
aHealth Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA.
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  • For correspondence: waleetti@yahoo.com
Bruce Fried
aHealth Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA.
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Karine Dubé
aHealth Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA.
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Sean Sylvia
aHealth Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA.
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Sandra Greene
aHealth Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA.
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Akudo Ikpeazu
bNational AIDS and Sexually Transmitted Illnesses Control Program, Federal Ministry of Health, Abuja, Nigeria.
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Emmanuel Kelechi Nwala
cJohn Snow Inc., Abuja, Nigeria.
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Figures

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  • FIGURE 1
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    FIGURE 1

    Respondents' Willingness to Pay for HIV Treatment Services With Changes in Income, Nigeria

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    FIGURE 2

    Percentage of Respondents' Willingness to Pay at Different Price Points of HIV Treatment Services (Demand Curve) in Nigeria

Tables

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    TABLE 1.

    Demographic Characteristics of Respondents to Survey of People Living With HIV Currently Receiving Free HIV Treatment Services in Nigeria (N=400)

    No. (%)
    Age, mean (±SD); median (IQR)36.1(±10.1); 34 (18–74)
    Age group
        18–28 years91 (22.75)
        29–39 years174 (43.00)
        40–50 years100 (25.00)
        51–61 years27 (6.75)
        Older than 62 years8 (2.00)
    Sex
        Female211 (52.72)
        Male189 (47.25)
    Marital status
        Cohabiting32 (8.00)
        Divorced/separated39 (9.72)
        Married161 (40.25)
        Single126 (31.50)
        Widowed42 (10.50)
    Level of education completed
        No education38 (10.00)
        Primary81 (21.00)
        Secondary153 (38.25)
        Postsecondary117 (29.00)
        Others48 (12.00)
    Employment status
        Salaried121 (30.25)
        Self-employed196 (49.00)
        Students38 (9.50)
        Unemployed45 (11.25)
    Monthly income
        No income76 (19.00)
        Less than 10,000 naira (<US$25)10 (2.50)
        10,000–20,000 naira (US$25–50)56 (14.00)
        20,000–30,000 naira (US$50–$75)71 (17.75)
        30,000–40,000 naira (US$75–$100)93 (23.25)
        50,000–100,000 naira (US$125–$250)67 (16.75)
        Above 100,000 naira (>US$250)16 (4.00)
        Would not disclose11 (2.75)
    Frequency of visit to the clinic
        Once a month86 (21.50)
        More than once a month5 (1.25)
        Once every 2 months75 (18.75)
        Once every 3 months234 (58.50)
    Duration on treatment
        Less than 1 year36 (9.00)
        Between 1–3 years132 (33.00)
        More than 3 years232 (58.00)
    Type of HIV treatment being received
        First-line treatment344 (86.00)
        Second-line treatment56 (14.00)
    • View popup
    TABLE 2.

    Survey Respondents' Willingness to Pay for HIV Treatment Services in Nigeria (N=400)

    VariablesNo. (%)
    Willing to pay for treatment if free treatment is stopped366 (91.50)
    Willingness to pay with increasing income371 (92.75)
    Willingness to pay with decreasing income114 (28.50)
    Sources of payment for treatment
        Family/friends34 (9.28)
        Personal income80 (21.86)
        Personal income with family/friends252 (68.85)
    Type of health facility preferred for paid services
        Government hospital327 (89.83)
        Private hospital37 (10.08)
    Preferred mode of payment
        Annual payment to the hospital37 (10.11)
        Payment on the day you come to the hospital272 (74.32)
        Payment through health insurance premium57 (15.57)
    • View popup
    TABLE 3.

    Bivariate Analysis of Survey Respondents' Willingness to Pay for HIV Treatment Services in Nigeria (N=400)

    VariableRespondent Willing to Pay, No. (%)X2P Value
    Sex
        Male175 (92.6).51
        Female191 (90.5)0.45
    Age category
        Older than 40 years242 (91.3).95
        Younger than 40 years124 (91.9)2.50
    Marital category
        Has a partner182 (94.3).07
        Has no partner184 (88.9)3.38
    Educational category
        Below secondary school107 (89.9).95
        Above secondary school259 (92.2)0.00
    Employment category
        Employed301(94.3).001a
        Unemployed65 (75.9)22.6
    Monthly income
        >Minimum wage184 (98.4).001a
        <Minimum wage182 (85.4)14.9
    Change in income
        Decrease in income114 (28.5).001a
        Increase in income371 (92.8)7.79
    Availability of support
        No support43 (62.3).001a
        Family and friend support318 (96.1)49.17
    Sources of money to be used to pay for HIV treatment services
        Personal income plus support275 (96.8)
        Personal income alone67 (91.8)3.42.06
    Perception of the monthly cost of HIV treatment services
        Cost is low170 (92.9)
        Cost is high196 (90.3)0.66.42
    History of previous payment for HIV treatment services
        No149 (89.8)
        Yes217 (92.7)1.24.27
    Awareness of benefits of treatment
        No5 (71.4)
        Yes361 (91.9)11.36.001a
    Duration the respondents have been on HIV treatment
        Less than 3 years150 (89.8)
        More than 3 years216 (92.7)1.17.28
    Preferred location to receive HIV treatment services
        Public hospital35 (95)
        Government hospital320 (98)2.35.33
    Existence of comorbidity with HIV infection
        No comorbidity345 (99.7)
        Yes comorbidity21 (38.9)0.91.50
    Frequency of clinic visits by respondents
        More than once a quarter141 (84.9)
        Once in a quarter225 (96.2)3.06.80
    Awareness of the benefits of adherence to HIV treatment services
        No5 (71.4)
        Yes361 (91.9)2.22.14
    • ↵a Statistically significant P values of .05. Only respondents who expressed willingness to pay were asked this question (n=366).

    • View popup
    TABLE 4.

    Output of Bivariate Analysis of Independent Variables With Maximum Amount Respondents Are Willing to Pay for HIV Treatment Services in Nigeria (n=400; 95% CI)

    VariableMax Amount Willing to Pay, No. (%)>N5,000 (US$12.5)X2P Value
    Sex
        Male27 (14.3)
        Female20 (9.5)1.38.24
    Age
        Older than 40 years20 (14.8)
        Younger than 40 years27 (10.2)0.37.54
    Marital category
        Has a partner31 (16.1)
        Has no partner16 (7.7)1.06.15
    Education completed
        Below secondary school23 (19.3)
        Secondary school and above24 (8.5)6.33.012a
    Employment category
        Employed39 (12.3)
        Not employed8 (9.6)2.0.16
    Monthly income
        >Minimum wage36 (19.3)
        <Minimum wage11 (5.2)3.45.001a
    Change in income
        Decrease in income137 (38)
        Increase in income116 (32)0.002.98
    Availability of support
        Family and friend support37 (11.1)
        No support10 (14.7)23.67.001a
    Sources of money to be used to pay for HIV treatment services
        Personal income alone39 (10.9)
        Personal income plus support8 (18.6)2.93.06
    Perception of the monthly cost of HIV treatment services
        Cost is low41 (11.7)
        Cost is high7 (14)1.13.42
    History of previous payment for HIV treatment services
        No26 (15.7)
        Yes21 (9)0.22.27
    Awareness of benefits of treatment
        No0 (0)
        Yes47 (12)0.01.99
    Duration the respondents have been on HIV treatment
        Less than 3 years11 (6.6)
        More than 3 years36 (15.5)1.02.33
    Preferred location to receive HIV treatment services
        Public hospital1 (2.7)
        Government hospital46 (14.1)1.05.33
    Existence of co-morbidity with HIV infection
        No40 (10.6)
        Yes7 (31.8)0.91.50
    Frequency of clinic visits by respondents
        More than once a quarter11 (6.6)
        Once in a quarter36 (15.4)0.59.80
    Awareness of the benefits of adherence to HIV treatment services
        No0 (0)
        Yes47 (12)3.58.14
    • ↵a Statistically significant P value of .05.

    • View popup
    TABLE 5.

    Multivariate Regression Analysis of Respondents' Willingness to Pay for HIV Treatment Services in Nigeria and Independent Variablesa (N=400)

    ModelOdds Ratio (95% Confidence Interval)P Value
    Age category
        Older than 40 years
        Younger than 40 years0.934 (−0.091, 0.032).351
    Marital category
        Has a partner
        Has no partner0.130 (−0.060, 0.052).897
    Educational category
        Below secondary school
        Secondary school and above0.355 (−0.064, 0.044).723
    Employment category
        Employed
        Not employed0.190 (0.015, 0.202).023b
    Monthly income
        >Minimum wage
        <Minimum wage2.389 (−0.046, 0.069).697
    Sex
        Male
        Female0.288 (−0.089, 0.019).199
    Level of treatment
        Public hospital
        Government hospital0.770 (−0.086, 0.038).442
    Duration on treatment
        Less than 3 years
        More than 3 years1.274 (−0.015, 0.070).204
    Co-morbidity with HIV
        No
        Yes0.119 (−0.110, 0.124).905
    Change in income
        Decrease in income
        Increase in Income2.015 (0.003, 0.229).045b
    Availability of financial support
        Family and friend support
        No support14.209 (0.151, 0.285).00b
    Sources of money to be used to pay for HIV treatment services
        Personal income alone
        Personal income plus support0.548 (1.523, 20.24).802
    Perception of the monthly cost of HIV treatment services
        Cost is low
        Cost is high1.493 (0.398, 2.273).892
    Awareness of consequences of nonadherence to HIV treatment
        No
        Yes1.856 (2.753, 10.274).136
    Awareness of starting treatment as soon as a diagnosis is completed
        No
        Yes0.998 (3.02, 65.507).075
    History of previous payment for HIV treatment services
        No
        Yes0.576 (0.443, 32.740).144
    Frequency of clinic visits
        More than once a quarter
        Once in a quarter2.457 (0.122, 0.523).784
    • ↵a Prob >F=0.000.

    • ↵b Statistically significant P value of .05.

    • View popup
    TABLE 6.

    Multivariate Regression Analysis of Maximum Amount Respondents Were Willing to Pay for HIV Treatment Services in Nigeria with Independent Variablesa (N=400)

    ModelOdds Ratio (95% Confidence Interval)P Value
    Age category
        Older than 40 years
        Younger than 40 years1.003 (−581.887, 117.994).19
    Marital category
        Has a partner
        Has no partner0.699 (−204.520, 429.975).49
    Educational category
        Below secondary school
        Secondary school and above0.797 (−181.817, 429.592).43
    Employment category
        Employed
        Not employed1.168 (−215.269, 844.746).24
    Awareness of early start of treatment
        No
        Yes0.646 (−254.997, 504.569).52
    Sex
        Male
        Female0.948 (−452.638, 158.094).34
    Monthly income
        >Minimum wage
        <Minimum wage2.476 (84.698, 737.233).014a
    Change in income
        Decrease in income
        Increase in income4.332 (1222.577, 505.391).00a
    Comorbidity with HIV
        No
        Yes0.821 (−385.006, 937.531).41
    Availability of financial support
        Family and friend support
        No support1.092 (−567.603, −87.090).008a
    Level of treatment
        Public hospital
        Government hospital0.383 (−418.816, 282.278).70
    Sources of funds
        Personal income alone
        Personal income plus support1.072 (0.053, 3.071).39
    Perception of cost of HIV treatment services
        Cost is low
        Cost is high1.18 (0.034, 23.345).99
    Awareness of consequences of nonadherence to treatment
        No
        Yes1.175 (−432.34, 123.345).67
    Frequency of clinic visits
        More than once a quarter
        Once in a quarter0.881 (0.072, 10.804).92
    Duration on treatment
        Less than 3 years
        More than 3 years0.457 (1.325, 7.824).73
    • ↵a Prob >F=0.000

    • View popup
    TABLE 7.

    Elasticity of Price for HIV Treatment in Nigeria, Patient Coverage, and Potential Cost Recovery

    Willingness to Pay Price PointsElasticity @ Naira 5,000Patient Coverage, %Potential Cost Recovery, %
    Naira 500 (US$1.25)0.85919
    Naira 1,000 (US$2.50)0.856512
    Naira 2,000 (US$5.00)1.296223
    Naira 3,000 (US$7.50)2.05429
    Naira 4,000 (US$10.00)0.632115
    Naira 5,000 (US$12.50)1816
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Global Health: Science and Practice: 10 (2)
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Sustainability of Funding for HIV Treatment Services: A Cross-Sectional Survey of Patients' Willingness to Pay for Treatment Services in Nigeria
Olawale Durosinmi-Etti, Bruce Fried, Karine Dubé, Sean Sylvia, Sandra Greene, Akudo Ikpeazu, Emmanuel Kelechi Nwala
Global Health: Science and Practice Apr 2022, 10 (2) e2100550; DOI: 10.9745/GHSP-D-21-00550

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Sustainability of Funding for HIV Treatment Services: A Cross-Sectional Survey of Patients' Willingness to Pay for Treatment Services in Nigeria
Olawale Durosinmi-Etti, Bruce Fried, Karine Dubé, Sean Sylvia, Sandra Greene, Akudo Ikpeazu, Emmanuel Kelechi Nwala
Global Health: Science and Practice Apr 2022, 10 (2) e2100550; DOI: 10.9745/GHSP-D-21-00550
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