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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
- Source :
- PLoS ONE, PLoS ONE, Vol 15, Iss 10, p e0238720 (2020)
- Publication Year :
- 2020
- Publisher :
- Public Library of Science (PLoS), 2020.
-
Abstract
- BackgroundGlobal HIV funding cutbacks have been accompanied by the adoption of user fees to address funding gaps in treatment programs. Our objective was to assess the impact of user fees on HIV care utilization and medication adherence in Nigeria.MethodsWe conducted a retrospective analysis of patients enrolled in care before (October 2012-September 2013) and after (October 2014-September 2015) the introduction of user fees in a Nigerian clinic. We assessed pre- vs. post-user fee patient characteristics and enrollment trends, and determined risk of care interruption, loss to follow-up, and optimal medication adherence.ResultsAfter fees were instituted, there was a 66% decline in patient enrollment and 75% decline in number of ART doses dispensed. There was no difference in the proportion of female clients (64% vs 63%, p = 0.46), average age (36 vs. 37 years, p = 0.15), or median baseline CD4 (220/ul vs. 222/uL, p = 0.24) in pre- and post-fee cohorts. There was an increase in clients employed and/or had tertiary education (24% vs. 32%, pConclusionsPatients enrolled in care after introduction of user fees in Nigeria were more likely to be educated or employed, and effectively retained in care after starting ART. However, fees were accompanied by a drastic reduction in new patient enrollment, suggesting that many patients may have been marginalized from HIV care.
- Subjects :
- RNA viruses
Male
Epidemiology
Economics
Human immunodeficiency virus (HIV)
Social Sciences
Patient characteristics
HIV Infections
Pathology and Laboratory Medicine
medicine.disease_cause
Ambulatory Care Facilities
Geographical Locations
Cohort Studies
0302 clinical medicine
Immunodeficiency Viruses
Medicine and Health Sciences
Medicine
Public and Occupational Health
030212 general & internal medicine
Hiv treatment
Virus Testing
Data Management
Multidisciplinary
Vaccination and Immunization
Medical Microbiology
Viral Pathogens
Viruses
Female
Pathogens
Research Article
Adult
Computer and Information Sciences
medicine.medical_specialty
Patient Dropouts
Patients
Anti-HIV Agents
Science
Immunology
030231 tropical medicine
MEDLINE
Nigeria
Antiretroviral Therapy
Medication adherence
Microbiology
Medication Adherence
Odds
03 medical and health sciences
Antiviral Therapy
Diagnostic Medicine
Retroviruses
Humans
In patient
Hiv services
Microbial Pathogens
Retrospective Studies
business.industry
Lentivirus
Organisms
Biology and Life Sciences
HIV
Health Care
Fees and Charges
Medical Risk Factors
Family medicine
People and Places
Africa
Lost to Follow-Up
Preventive Medicine
Health Expenditures
business
Finance
Subjects
Details
- ISSN :
- 19326203
- Volume :
- 15
- Database :
- OpenAIRE
- Journal :
- PLOS ONE
- Accession number :
- edsair.doi.dedup.....d660d198629b4ff2dfe8e11a1ccb462e