| Peer-Reviewed

Economic Burden of Accessing Antiretrovirals Among People Living with HIV; Findings from a Cross-Sectional Survey in Lagos State, Nigeria

Received: 23 June 2020     Accepted: 15 July 2020     Published: 13 August 2020
Views:       Downloads:
Abstract

Background: HIV/AIDS is one of the major diseases with multifaceted burdens; health, emotional and financial. After the introduction of the Antiretroviral Therapy (ART), HIV/AIDS became a chronic disease that requires long-term management thus competing with other day-to-day economic obligations of People Living with HIV/AIDS (PLWH). There have been limited studies assessing economic burden of accessing ART treatment vis-a-vis catastrophic health expenditure (CHE) in this environment. Therefore, this survey explores the CHE resulting from accessing ART treatment and identifying some of the predictors for CHE among PLWH in Lagos State, Nigeria. Materials and methods: This study was a descriptive cross-sectional, quantitative survey that was carried out among 217 consenting PLWH recruited from 15 Support groups in Lagos State, Nigeria. The data was collected using 29-items self-administered questionnaire (research assistants aided PLWH who cannot read or write) developed from the review of relevant literatures. The data were analyzed using SPSS version 20. Chi-square at p-value of < 0.05 was used to determine significance of factors associated with CHE. Results: Age of the respondents was 42.81±8.517 years. Female respondents were more than 70% (171) and about half of the respondents, 109 (50.2%) were married. Above half, 129 (59%), of the respondents attend drug pick-up sites for their ARVs monthly. Less than 60% of the respondents (mean annual income 1111.203±821.371 dollars) earn below $1000 annually with 41.2%, 39.0% and 19.8% of the respondents in low, middle and high income groups respectively. Only 5% of the PLWH expend $200 annually for refill of ARVs. Considering the global definition of CHE (health expenditure>10% of household consumption,) 40% of the surveyed respondents experienced CHE. Using chi-square to determine factors associated with CHE among respondents; occupation, income group and ARVs refill frequency were significant at P<0.05. However, the binary logistic regression identified formal occupation (aOR=0.025, 95% C.I=0.02-0.35, p-value=0.006), being in middle income group (aOR=0.007, 95% C.I=0.001-0.05, p-value=0.0001) and high income group (aOR=0.035, 95% C.I=0.10-0.12, p-value=0.0001) and visiting health care facility for ARVs refill bi-monthly (aOR=17.555, 95% C.I=4.64-66.40, p-value=0.0001) as predictors of CHE among respondents. Conclusions: The results of this survey revealed that having formal employment, belonging to middle and high income groups protects respondents from CHE while bi-monthly ARVs refill predisposes PLWH in this survey to CHE.

Published in International Journal of HIV/AIDS Prevention, Education and Behavioural Science (Volume 6, Issue 2)
DOI 10.11648/j.ijhpebs.20200602.12
Page(s) 38-43
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Catastrophic Health Expenditure (CHE), Antiretroviral Therapy (ART), Antiretroviral (ARV), People Living with HIV (PLWH), Income Groups

References
[1] The Institute for Health Metrics and Evaluation's Global Burden of Disease Study 2017. 2017 GLOBAL HIV STATISTICS, pg 1-6.
[2] Joint United Nations Programme on HIV/AIDS (UNAIDS) Data 2018.
[3] The Nigeria HIV/AIDS Indicator & Impact Survey (NAIIS 2018). NAIIS 2018 National summary sheet for preliminary findings pg1-5. March 2019.
[4] Mahlet Gezahegn & Mukti Upadhyay, 2014. "The Effect of HIV/AIDS on Economic Growth of Southern African Countries," Asian Economic and Financial Review, Asian Economic and Social Society, vol. 4 (9), pages 1146-1157, September.
[5] Bell C, Devarajan S, Gersbach H. The long-run economic costs of AIDS: theory and an application to South Africa. Germany: University of Heidelberg; 2003.
[6] Kumarasamy N, Ventatesh KK, Mayer KH, Freedberg K. Financial burden of health services for people with HIV/AIDS in India. Indian Journal of Medical Research. 2007; 126: 509-17.
[7] Duraisamy P, Ganesh AK, Homan R, Kumarasamy N, Castle C, Sripriya P, Mahendra V, Solomon S. Costs and financial burden of care and support services to PLHA and households in south India. AIDS Care. 2006; 18 (2): 121-7.
[8] Poudel, A. N., Newlands, D., & Simkhada, P. (2017). The economic burden of HIV / AIDS on individuals and households in Nepal: a quantitative study. BMC Health Services Research, 1-13. https://doi.org/10.1186/s12913-017-1976-y.
[9] Onoka C, Onwujekwe O, Uzochukwu B, Ezumah N (2012) Why are states not adopting the formal sector programme of the NHIS and what strategies can encourage adoption? Policy brief. Health Policy Research Group, College of Medicine, University of Nigeria, Enugu.
[10] Ekman B. Catastrophic health payments and health insurance: some counterintuitive evidence from one low-income country. Health Policy 2007; 83: 304-13 doi: 10.1016/j.healthpol.2007.02.004 pmid: 17379351.
[11] Ezat, S., Puteh, W., & Almualm, Y. (2017). iMedPub Journals Catastrophic Health Expenditure among Developing Countries, 1-5. https://doi.org/10.21767/2254-9137.100069.
[12] Wagstaff Adam, Gabriela Flores, Justine Hsu, Marc-François Smitz, Kateryna Chepynoga, Leander R Buisman, Kim van Wilgenburg, Patrick Eozenou (2017). Progress on catastrophic health spending in 133 countries: a retrospective observational study. The Lancet Global Health volume 6, issue 2 December 13, 2017 http://dx.doi.org/10.1016/ S2214-109X(17)30429-1.
[13] Bhavsarl, A. B., & Srivastava, D. (2015). Economic burden of HIV / AIDS on households: Cross-sectional study in the context of Navi Mumbai, India. Global Journal of Medicine and Public Health, 4 (6), 1-11.
[14] https://www.ibm.com/support/pages/spss-statistics-20-available-download.
[15] Onoka, C. A., Onwujekwe, O. E., Hanson, K., Uzochukwu, B. S. (2011). Examining Catastrophic Health Expenditures at Variable Thresholds Using Household Consumption Expenditure Diaries. Tropical Medicine and International Health 16 (10): 1334-1341. doi: 10.1111/j.1365-3156.2011.02836.x..
[16] Cleopatra, Ibukun., & Eunice, Komolafe. (2018). Household Catastrophic Health Expenditure : Evidence from Nigeria. Scientific & Academic Publishing, 6 (1), 1-8. https://doi.org/10.5923/j.m2economics.20180601.01.
[17] Etiaba, E., Onwujekwe, O., Torpey, K., Uzochukwu, B., & Chiegil, R. (2016). What Is the Economic Burden of Subsidized HIV / AIDS Treatment Services on Patients in Nigeria and Is This Burden Catastrophic to Households?, 1-14. https://doi.org/10.1371/journal.pone.0167117.
[18] Apanga S, Punguyire D, Adjei G (2012) Estimating the cost to rural ambulating HIV/AIDS patients on Highly Active Antiretroviral Therapy (HAART) in rural Ghana: a pilot study. The Pan African Medical Journal 12.
[19] Onwujekwe O, Dike N, Chukwuka C, Uzochukwu B, Onyedum C. (2009) Examining catastrophic costs and benefit incidence of subsidized antiretroviral treatment (ART) programme in south-east Nigeria. Health Policy 90: 223±229. doi: 10.1016/j.healthpol.2008.10.006 PMID: 19036466.
[20] Adisa, O. (2015). Investigating Determinants of Catastrophic Health Spending Among Poorly Insured Elderly Households in Urban Nigeria. International Journal for Equity in Health 14: 79. DOI 10.1186/s12939-015-0188-5.
[21] Wabiri N, Taffa N (2013) Socio-economic inequality and HIV in South Africa. BMC Public Health.
[22] MarõÂ-Dell'Olmo M, Rodrõ Âguez-Sanz M, Garcia-Olalla P, PasarõÂn MI, Brugal MT. (2007) Individual and community-level effects in the socioeconomic inequalities of AIDS-related mortality in an urban area of southern Europe. Journal of Epidemiology and Community Health 61: 232±240. doi: 10.1136/jech.2006.048017 PMID: 17325402.
[23] Dray-Spira R, Lert F (2003) Social health inequalities during the course of chronic HIV disease in the era of highly active antiretroviral therapy. AIDS 17: 283±290. doi: 10.1097/01.aids.0000042941.55529.da PMID: 12556681.
[24] Nsimba SED., Irunde H., Comoro C. Barriers to ARV adherence among HIV/AIDS positive persons taking Anti-Retroviral Therapy in two Tanzanian regions 8-12 months after program initiation. Journal of AIDS and Clinical Research, 2010; 1: 111.
[25] Kagee A., Remien RH., Berkman A., Hoffman S., Campos L., Swartz L. 2011. Structural barriers to ART adherence in South Africa: Challenges and potential ways forward. Global Public Health, 2011 January, 6 (1): 83-97.
[26] Joglekar N., Paranjape R., Jain R., Rahane G., Potdar R., Reddy KS., Sahay S. Barriers to ART adherence & follow ups among patients attending ART centres in Maharashtra, India. Indian Journal of Medical Research, 2011 Dec; 134 (6): 954-959.
Cite This Article
  • APA Style

    Ogunnaike Adewale Adeyemi, Adewole David, Temowo Oluseyi Sunday, Fisher Oladipupo, Essien Michael, et al. (2020). Economic Burden of Accessing Antiretrovirals Among People Living with HIV; Findings from a Cross-Sectional Survey in Lagos State, Nigeria. International Journal of HIV/AIDS Prevention, Education and Behavioural Science, 6(2), 38-43. https://doi.org/10.11648/j.ijhpebs.20200602.12

    Copy | Download

    ACS Style

    Ogunnaike Adewale Adeyemi; Adewole David; Temowo Oluseyi Sunday; Fisher Oladipupo; Essien Michael, et al. Economic Burden of Accessing Antiretrovirals Among People Living with HIV; Findings from a Cross-Sectional Survey in Lagos State, Nigeria. Int. J. HIV/AIDS Prev. Educ. Behav. Sci. 2020, 6(2), 38-43. doi: 10.11648/j.ijhpebs.20200602.12

    Copy | Download

    AMA Style

    Ogunnaike Adewale Adeyemi, Adewole David, Temowo Oluseyi Sunday, Fisher Oladipupo, Essien Michael, et al. Economic Burden of Accessing Antiretrovirals Among People Living with HIV; Findings from a Cross-Sectional Survey in Lagos State, Nigeria. Int J HIV/AIDS Prev Educ Behav Sci. 2020;6(2):38-43. doi: 10.11648/j.ijhpebs.20200602.12

    Copy | Download

  • @article{10.11648/j.ijhpebs.20200602.12,
      author = {Ogunnaike Adewale Adeyemi and Adewole David and Temowo Oluseyi Sunday and Fisher Oladipupo and Essien Michael and Dada Julianah},
      title = {Economic Burden of Accessing Antiretrovirals Among People Living with HIV; Findings from a Cross-Sectional Survey in Lagos State, Nigeria},
      journal = {International Journal of HIV/AIDS Prevention, Education and Behavioural Science},
      volume = {6},
      number = {2},
      pages = {38-43},
      doi = {10.11648/j.ijhpebs.20200602.12},
      url = {https://doi.org/10.11648/j.ijhpebs.20200602.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijhpebs.20200602.12},
      abstract = {Background: HIV/AIDS is one of the major diseases with multifaceted burdens; health, emotional and financial. After the introduction of the Antiretroviral Therapy (ART), HIV/AIDS became a chronic disease that requires long-term management thus competing with other day-to-day economic obligations of People Living with HIV/AIDS (PLWH). There have been limited studies assessing economic burden of accessing ART treatment vis-a-vis catastrophic health expenditure (CHE) in this environment. Therefore, this survey explores the CHE resulting from accessing ART treatment and identifying some of the predictors for CHE among PLWH in Lagos State, Nigeria. Materials and methods: This study was a descriptive cross-sectional, quantitative survey that was carried out among 217 consenting PLWH recruited from 15 Support groups in Lagos State, Nigeria. The data was collected using 29-items self-administered questionnaire (research assistants aided PLWH who cannot read or write) developed from the review of relevant literatures. The data were analyzed using SPSS version 20. Chi-square at p-value of 10% of household consumption,) 40% of the surveyed respondents experienced CHE. Using chi-square to determine factors associated with CHE among respondents; occupation, income group and ARVs refill frequency were significant at P<0.05. However, the binary logistic regression identified formal occupation (aOR=0.025, 95% C.I=0.02-0.35, p-value=0.006), being in middle income group (aOR=0.007, 95% C.I=0.001-0.05, p-value=0.0001) and high income group (aOR=0.035, 95% C.I=0.10-0.12, p-value=0.0001) and visiting health care facility for ARVs refill bi-monthly (aOR=17.555, 95% C.I=4.64-66.40, p-value=0.0001) as predictors of CHE among respondents. Conclusions: The results of this survey revealed that having formal employment, belonging to middle and high income groups protects respondents from CHE while bi-monthly ARVs refill predisposes PLWH in this survey to CHE.},
     year = {2020}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Economic Burden of Accessing Antiretrovirals Among People Living with HIV; Findings from a Cross-Sectional Survey in Lagos State, Nigeria
    AU  - Ogunnaike Adewale Adeyemi
    AU  - Adewole David
    AU  - Temowo Oluseyi Sunday
    AU  - Fisher Oladipupo
    AU  - Essien Michael
    AU  - Dada Julianah
    Y1  - 2020/08/13
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ijhpebs.20200602.12
    DO  - 10.11648/j.ijhpebs.20200602.12
    T2  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
    JF  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
    JO  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
    SP  - 38
    EP  - 43
    PB  - Science Publishing Group
    SN  - 2575-5765
    UR  - https://doi.org/10.11648/j.ijhpebs.20200602.12
    AB  - Background: HIV/AIDS is one of the major diseases with multifaceted burdens; health, emotional and financial. After the introduction of the Antiretroviral Therapy (ART), HIV/AIDS became a chronic disease that requires long-term management thus competing with other day-to-day economic obligations of People Living with HIV/AIDS (PLWH). There have been limited studies assessing economic burden of accessing ART treatment vis-a-vis catastrophic health expenditure (CHE) in this environment. Therefore, this survey explores the CHE resulting from accessing ART treatment and identifying some of the predictors for CHE among PLWH in Lagos State, Nigeria. Materials and methods: This study was a descriptive cross-sectional, quantitative survey that was carried out among 217 consenting PLWH recruited from 15 Support groups in Lagos State, Nigeria. The data was collected using 29-items self-administered questionnaire (research assistants aided PLWH who cannot read or write) developed from the review of relevant literatures. The data were analyzed using SPSS version 20. Chi-square at p-value of 10% of household consumption,) 40% of the surveyed respondents experienced CHE. Using chi-square to determine factors associated with CHE among respondents; occupation, income group and ARVs refill frequency were significant at P<0.05. However, the binary logistic regression identified formal occupation (aOR=0.025, 95% C.I=0.02-0.35, p-value=0.006), being in middle income group (aOR=0.007, 95% C.I=0.001-0.05, p-value=0.0001) and high income group (aOR=0.035, 95% C.I=0.10-0.12, p-value=0.0001) and visiting health care facility for ARVs refill bi-monthly (aOR=17.555, 95% C.I=4.64-66.40, p-value=0.0001) as predictors of CHE among respondents. Conclusions: The results of this survey revealed that having formal employment, belonging to middle and high income groups protects respondents from CHE while bi-monthly ARVs refill predisposes PLWH in this survey to CHE.
    VL  - 6
    IS  - 2
    ER  - 

    Copy | Download

Author Information
  • Department of Health Policy & Management, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria

  • Department of Health Policy & Management, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria

  • Department of Medical Services, Lagos State Health Service Commission, Lagos Island, Nigeria

  • Projects Department, Lagos State AIDS Control Agency, Lagos Island, Nigeria

  • Projects Department, Lagos State AIDS Control Agency, Lagos Island, Nigeria

  • Strategic Information, APIN Public Health Initiatives, Oshogbo, Nigeria

  • Sections