The impact of user fees on uptake of HIV services and adherence to HIV treatment: Findings from a large HIV program in Nigeria

Ahonkhai, Aima A.; Regan, Susan; Idigbe, Ifeoma; Adeniyi, Olayemi; Aliyu, Muktar H.; Okonkwo, Prosper; Adeola, Juliet; Losina, Elena; Musa, Zaidat; Ezechi, Oliver; Freedberg, Kenneth A.

doi:10.1371/journal.pone.0238720

Cited by 8 publications

(8 citation statements)

References 25 publications

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“…Furthermore, while prior HIV treatment interventions, in particular, have adopted a 1:10 ratio of navigator-peers [ 57 ], this was perceived as unsustainable for a volunteer force. These findings are consistent with concerns among stakeholders across SSA [ 58 ], and in Nigeria more specifically [ 59 ], about efficiencies in systems of HIV care given reduced funding from external donors, which have impacted the quantity [ 60 ] and quality of HIV-related service provision [ 61 ], and care engagement [ 62 ]. An umbrella review of 39 systematic reviews of the effectiveness of volunteer workers concluded that they were as good as or better in supporting positive outcomes for a variety of health conditions, however, they were not as good at complex tasks, such as diagnosis and counselling.…”

Section: Discussionsupporting

confidence: 75%

Adaptation of evidence-based approaches to promote HIV testing and treatment engagement among high-risk Nigerian youth

et al. 2021

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Background Nigeria has the second highest number of people living with HIV (PLWH) globally, and evidence-based approaches are needed to achieve national goals to identify, treat, and reduce new infections. Youth between the ages of 15–24, including young men who have sex with men (YMSM), are disproportionately impacted by the Nigerian HIV epidemic. The purpose of this study was to inform adaptation of evidence-based peer navigation and mHealth approaches (social media outreach to promote HIV testing; short messaging service text message reminders to promote HIV treatment engagement) to the local context within iCARE Nigeria, a multi-phase study designed to investigate combination interventions to promote HIV testing and care engagement among youth in Nigeria. Methods To elicit expert and community perspectives, a local group of advisors from academia, community, and governmental sectors provided feedback on intervention adaptation, which then informed a series of focus groups with stakeholders in Ibadan, Nigeria. Focus group data were collected over a period of three days in December of 2018. Participants in focus groups included YMSM and HIV-positive youth in care ages 16–24, and HIV service providers from local AIDS service organizations (ASO). Groups were stratified by HIV serostatus, gender, and stakeholder type. Focus group sessions were conducted using a semi-structured interview guide, audio-recorded, transcribed verbatim, and analyzed using a content analysis approach. Results Local experts recommended intervention adaptations specific to the status of peer navigators as volunteers, peer characteristics (slightly older age, high maturity level, HIV/YMSM status), and intervention characteristics and resources (low navigator to peer ratio; flexible matching by demographic and social characteristics; social media platforms and content). Five focus group discussions with stakeholders, including 27 participants were conducted to elicit feedback on these and other potential adaptations. Youth participants (n = 21) were mean age 20 years (range = 16–24); 76% HIV-positive, 76% men and 48% MSM. Service providers (n = 6) represented both HIV prevention and care services. Participants across stratified subgroups reported largely positive perceptions and high perceived acceptability of both mHealth and peer navigation strategies, and echoed the recommendations of the advisory group for volunteer-based navigators to promote altruism, with a low navigator-peer ratio (1:5). Participants emphasized the need to incorporate minimal mobile data use strategies and popular social media platforms among YMSM (e.g., Facebook, Grindr) for widespread access and reach of the interventions. Conclusions In Ibadan, Nigeria, stakeholders support the adaptation of combined mHealth and peer navigation strategies to promote HIV testing and care engagement among high-risk youth. Recommended adaptations for the local context reflect concerns about the feasibility and sustainability of the intervention and are expected to improve accessibility and acceptability.

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Section: Discussionsupporting

confidence: 75%

Adaptation of evidence-based approaches to promote HIV testing and treatment engagement among high-risk Nigerian youth

et al. 2021

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“…Some of the structural barriers identified for facility-based COVID-19 testing, such as the cost of healthcare, unavailability of diagnostics and therapies, and rejection of the "diseased" by certain sections of the public, might affect the uptake of self-testing if left unaddressed. The cost of healthcare already hampers the uptake of and adherence to HIV services (27) and preventive care (28), and it is a critical consideration for provision of laboratory services (29). The informants suggested that self-testing devices should be subsidized, although concern was expressed by some that the cost of isolation might be a greater worry than the cost of self-testing.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 self-testing in Nigeria: Stakeholders’ opinions and perspective on its value for case detection

Undelikwo

Shilton

Foláyan

et al. 2022

Preprint

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Background COVID-19 testing coverage is limited in Nigeria. Access to SARS-CoV-2 self-testing kits may help improve the detection of asymptomatic and mildly symptomatic cases and increase the currently low rate of COVID-19 testing in the country. Before implementing SARS-CoV-2 self-testing in Nigeria, it is imperative to assess the populations perceptions regarding this innovation. We therefore conducted a qualitative study to investigate peoples values and preferences for SARS-CoV-2 self-testing in Nigeria. Methods We used semi-structured interviews and focus group discussions among healthcare workers, community representatives, and public health implementors to explore values and perceptions around various aspects of COVID-19 testing, including conventional COVID-19 testing, SARS-CoV-2 self-testing, the safe and effective use of SARS-CoV-2 self-testing, actions upon receiving a positive SARS-CoV-2 self-test result, and future prospects for SARS-CoV-2 self-testing. Results Respondents reported that there is limited availability of conventional SARS-CoV-2 testing in Nigeria. While just a few respondents were familiar with SARS-CoV-2 testing, respondents generally supported the use of SARS-CoV-2 self-testing as they felt it could assist with early case detection and improve access to testing. Concerns relating to the use of SARS-CoV-2 self-testing were majorly about the ability among low literacy populations to use and interpret the test, the affordability of tests, equity of access, and the availability of healthcare system support for those who test positive. Conclusion Though the public perceive multiple benefits associated with access to SARS-CoV-2 self-testing, the efficiency of the national health service delivery system may limit access of the users of the kits to psychosocial and clinical support. In Nigeria, where COVID-19 vaccine coverage is low and the risk of further waves of COVID-19 is high, self-testing may assist in the prompt detection of cases and contribute to halting the spread of the virus.

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“…The CPARP model still offers an opportunity for busy patients in urban settings who are able to pay a small user fee. In other studies, user fees have had a mixed impact on access to services, especially in West Africa [ 25 ]. During the COVID‐19 pandemic when movement was restricted and the cost of transportation increased, we observed increased enrolment in this DSD program.…”

Section: Discussionmentioning

confidence: 99%

Differentiated service delivery models among PLHIV in Akwa Ibom and Cross River States, Nigeria during the COVID‐19 pandemic: descriptive analysis of programmatic data

et al. 2021

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IntroductionThe rapid increase in the number of people living with HIV (PLHIV) on antiretroviral therapy (ART) in Akwa Ibom and Cross River states in Nigeria led to overcrowding at clinics. Patients were devolved to receive ART refills through five differentiated service delivery (DSD) models: fast‐track (FT), adolescent refill clubs (ARCs), community pharmacy ART refill programs (CPARPs), community ART refill clubs (CARCs) and community ART refill groups (CARGs) designed to meet the needs of different groups of PLHIV. In the context of COVID‐19‐related travel restrictions, out‐of‐facility models offered critical mechanisms for continuity of treatment. We compared retention and viral suppression among those devolved to DSD with those who continued standard care at facilities.MethodsA retrospective cohort study was conducted among patients devolved to DSD from January 2018 to December 2020. Bivariate analyses were conducted to assess differences in retention and viral suppression by socio‐demographic characteristics. Kaplan–Meier assessed retention at 3, 6, 9 and 12 months. Differences in proportions were compared using the chi‐square test; a p‐value of <0.05 was considered significant.ResultsA total of 40,800 PLHIV from 84 facilities received ART through the five models: CARC (53%), FT (19.1%), ARC (12.1%), CPARP (10.4%) and CARG (5.4%). Retention rates at 6 months exceeded 96% for all models compared to 94% among those continuing standard care. Among those using DSD, retention rate at 12 months was higher among adults than children (97.8% vs. 96.7%, p = 0.04). No significant sex differences in retention rates were found among those enrolled in DSD. Viral suppression rates among PLHIV served through DSD were significantly higher among adults than children (95.4% vs. 89.2%; p <0.01). Among adults, 95.4% enrolled in DSD were virally suppressed compared to 91.8% of those in standard care (p <0.01). For children, 89.2% enrolled in DSD were virally suppressed compared to 83.2% in standard care (p <0.01).ConclusionsPLHIV receiving ART through DSD models had retention but higher viral suppression rates compared to those receiving standard care. Expanding DSD during COVID‐19 has helped ensure uninterrupted access to ART in Nigeria. Further scale‐up is warranted to decongest facilities and improve clinical outcomes.

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The impact of user fees on uptake of HIV services and adherence to HIV treatment: Findings from a large HIV program in Nigeria

Cited by 8 publications

References 25 publications

Adaptation of evidence-based approaches to promote HIV testing and treatment engagement among high-risk Nigerian youth

Adaptation of evidence-based approaches to promote HIV testing and treatment engagement among high-risk Nigerian youth

COVID-19 self-testing in Nigeria: Stakeholders’ opinions and perspective on its value for case detection

Differentiated service delivery models among PLHIV in Akwa Ibom and Cross River States, Nigeria during the COVID‐19 pandemic: descriptive analysis of programmatic data

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