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. 2023 Nov 16;18(11):e0289507.
doi: 10.1371/journal.pone.0289507. eCollection 2023.

Willingness to pay for antiretroviral therapy, viral load, and premium services; A contingent valuation survey of people living with HIV in southern Nigeria

Olusola Sanwo  1 , Ihoghosa Iyamu  2 , Augustine Idemudia  3 , Titilope Badru  1 , Sylvia Ekponimo  1 , Dorothy Oqua  4 , Olusesan A Makinde  5 , Gambo G Aliyu  6 , Abimbola Kola-Jebutu  3 , Jemeh Egwuagu-Pius  3 , Chika Obiora-Okafo  3 , Moses Bateganya  3 , Iorwakwagh Apera  1 , Satish Raj Pandey  7 , Hadiza Khamofu  1
Affiliations

Willingness to pay for antiretroviral therapy, viral load, and premium services; A contingent valuation survey of people living with HIV in southern Nigeria

Olusola Sanwo et al. PLoS One. .

Abstract

Background: With stagnating funding for HIV and AIDS control programs in Nigeria, alternative funding models for antiretroviral therapy (ART) including out of pocket payment are being considered to sustain momentum epidemic control targets. We assessed willingness to pay for ART related services, and factors associated with willingness to pay.

Methods: Between July and August 2019, we conducted a survey among people living with HIV (PLHIV) on ART in 3 states in southern Nigeria. Randomly sampled respondents on ART for at least 6 months, aged ≥ 18 years, able to communicate in English or pidgin English, and consenting to the survey were enrolled. Respondents were asked if they were willing to pay for clinical consultation, antiretroviral drugs (ARVs), viral load testing services and premium ART services (including fast track services). Respondents indicating willingness to pay for any of these services were asked the maximum amount they were willing to pay using contingent valuation methodology. We assessed the weighted proportions of PLHIV on ART willing to pay for ART and used survey-featured logistic regression measures to assess sociodemographic and ART related factors associated with willingness to pay for ART services.

Results: Overall, 1,598 PLHIV with a mean age of 39.03 years (standard deviation [SD]: 11.23 years), were included in this analysis. Of these, 65.8% (1,079), 73.9% (1,192), 61.0% (995) and 33.6% (472) were willing to pay for ART consultation, ARVs, viral load testing services and premium ART services respectively. The median maximum amount PLHIV were willing to pay for clinical consultation and for ARVs was NGN1,000 (USD equivalent of $2.78; interquartile range [IQR]: 500-2,000) respectively, and NGN2,500 (USD equivalent of $6.94; IQR: NGN1,000-5,000) and NGN2,000 (USD equivalent of $5.56; IQR: NGN1,000-3,000) for viral load testing and premium ART services respectively. Receiving ART in Lagos state, being employed and having a monthly income of NGN100,000 or more was associated with willingness to pay for the various ART services.

Conclusion: We found generally high-level of willingness to pay for ART consultation, ARVs and viral load testing services but low willingness to pay for premium ART services among PLHIV on ART. The maximum amount PLHIV were willing to pay for various ART services fell short of benchmarks for alternative funding but can potentially supplement ART by funding differentiated service delivery models that require nominal amounts to facilitate person-centered differentiated service delivery models.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Illustration of contingent valuation method for eliciting maximum amount willing to pay for consultation, ARVs, viral load and premium services.
Fig 2
Fig 2. Flow chart showing inclusion of respondents for the study: Willingness to pay for HIV services survey 2019—Nigeria.
Fig 3
Fig 3. Cumulative plots of amounts PLHIV are willing to pay for various HIV treatment and care services: Willingness to pay for HIV services survey 2019 –Nigeria.
WTP: Willing to pay; NGN: Nigerian Naira; ARVs: Antiretroviral drugs.
See this image and copyright information in PMC

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