Institution of User Fees Results in Large Drop in ART Use in Nigeria

摘要

In a retrospective study from Nigeria, decreased funding for HIV treatment necessitated user fees, which resulted in a 66% decrease in enrollments and a 75% decrease in antiretroviral therapy doses dispensed. Global funding for HIV treatment has decreased in recent years. In Nigeria, annual support by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) decreased by US$83 million between 2011 and 2015 in a country where 80% of people subsist on less than US$2 per day. For this retrospective analysis, investigators compared HIV-patient demographics and antiretroviral therapy (ART) characteristics for the years before and after October 1,2014, when user fees were introduced (e.g., costs of US$3 for an HIV test and US$45 for new-patient labs and annual costs of US$28 for routine labs and US$72 for ART pickup). The study population consisted of patients seen at one large PEPFAR-supported public clinic in Lagos.