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

• Published in: PloS one 2020-10, Vol.15 (10), p.e0238720-e0238720
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiretroviral drugs; Antiretroviral therapy; Biology and Life Sciences; Care and treatment; CD4 antigen; Clients; Computer and Information Sciences; Drug dosages; Economic aspects; Funding; Health care costs; Health risks; HIV; HIV infections; Human immunodeficiency virus; Influence; Medicine and Health Sciences; Patient compliance; People and Places; Risk; Social Sciences; User fees
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0238720

Global 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. We 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. After 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%, p