Sustainability of Funding for HIV Treatment Services: A Cross-Sectional Survey of Patients' Willingness to Pay for Treatment Services in Nigeria

Many Nigerian patients are willing to pay for HIV treatment, but several socioeconomic factors play significant roles in willingness and capacity to pay for treatment and the maximum amounts patients are willing to pay. Key Findings Most people living with HIV (PLHIV) receiving free HIV treatment services are willing to pay for the services if such free treatment services are no longer available. The socioeconomic status of PLHIV plays a critical role in the willingness to pay for treatment. The willingness is further enhanced by the availability of financial support from friends and family. The maximum price that most patients are willing to pay for HIV treatment services is less than the current cost of providing services and the different price points are elastic relative to the estimated current price of providing services. Key Implications The domestic funding for HIV treatment services in low-income countries can be improved through cost recovery from patient contribution to the cost of treatment. Equitable access to HIV treatment services can be achieved by ensuring that patients are segmented based on socioeconomic status to identify those that can benefit from free services, subsidized and full-priced payment for treatment services. Willingness to pay for HIV treatment services and funding sustainability of the HIV treatment program can be enhanced by reducing the cost of treatment, which improves treatment affordability. ABSTRACT Background: About 50% of individuals needing HIV treatment are unable to access required services primarily due to the inability of the Nigerian HIV treatment program to meet patient needs. We explored patient willingness to pay for HIV treatment, which can inform the feasibility of cost recovery through patient fees to contribute to the funding of HIV treatment services in Nigeria. Methods: We conducted a cross-sectional survey of 400 people living with HIV randomly selected from 15 health care facilities providing free HIV treatment services in 2 medium and high HIV burden states (Lagos, Enugu) and the Federal Capital Territory Abuja. We calculated the elasticity of the price that patients were willing to pay per month relative to the estimated current cost of providing HIV treatment services per patient and determined the patient coverage and potential cost recovery at each price point. Results: We found that 92% of patients were willing to pay for HIV treatment. The mean amount patients were willing to pay was 3,000 naira (US$7.50) per month with about 18% of patients willing to pay the current monthly price of 5000 naira (US$12.50). The availability of financial support from family and friends (odds ratio [OR]=14.209; P=.001; 95% confidence interval [CI]=0.151, 0.285), lack of employment (OR=0.190; P=.02; 95% CI=0.015, 0.202), monthly income (OR=2.476; P<.001; 95% CI=84.698, 737.233), and change in monthly income (OR=2.015; P<.001; 95% CI=0.003, 0.229) were associated with willingness to pay. Conclusion: Many Nigerian patients are willing to contribute to funding for HIV treatment and this can enhance domestic funding for HIV treatment and equitable access to treatment through proper segmentation of patients based on willingness and capacity to pay. Measures must be put in place to reduce the cost of accessing HIV treatment and promote financial empowerment of people living with HIV to improve willingness to pay for treatment.