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Lagos, Nigeria: Is paying for HIV treatment bad for you?

Lagos, Nigeria: Is paying for HIV treatment bad for you?. Comprehensive HIV-care in the General Hospital Lagos MSF-Holland/Germany. ART Availability. ARVs available in the country since 1990s Private sector provision, pay out of pocket 2002: public sector funded ART-program

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Lagos, Nigeria: Is paying for HIV treatment bad for you?

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  1. Lagos, Nigeria: Is paying for HIV treatment bad for you? Comprehensive HIV-care in the General Hospital Lagos MSF-Holland/Germany

  2. ART Availability • ARVs available in the country since 1990s • Private sector provision, pay out of pocket • 2002: public sector funded ART-program • 10 000 patients (user fee based) • Nov 2003-Jan 2004-crisis: Gov. Program out of stocks

  3. Project description • Start November 2003 • July 2004: first patient on ARV • April 2006: • Total Patients enrolled: 1862 • Patients on ART: 1275 • Mortality: 3.1 % • Lost to Follow UP (2M): 7.8% • WHO-stage 3/4: 78 % • ARV-Experienced patients: 13 %

  4. Why do Experienced patients come to MSF-clinic ? • Questionnaire to assess: • Treatment background • Which drugs , how long • ART interruptions • ART expenses in the user fee based system

  5. WHAT ARE OUR FINDINGS SO FAR

  6. Income of HIV+ patients in the Lagos General Hospital USD

  7. What do patients pay for ART in non-MSF-sites ? 122 experienced patients interviewed : Average costs = 40 USD

  8. ART Interruption in Patients with ARV Experience NUMBER OF PATIENTS WITH TREATMENT INTERRUPTION NUMBER OF PATIENTS WITHOUT TREATMENT INTERRUPTION 34 27.8 % 72.1 % n= 122 88 • 72% of all ARV experienced interviewed people had ART interruption • average cumulative interruption time: 6 month • 8 % shared the ARVs with their partners

  9. Reasons why ART was stopped FINANCE out of 17% govt.stock 0% 1% SIDE 1% EFFECTS 6% SOCIAL HEALTH OK 61% FAILURE 14% IMPROVE OTHER • Results of ARV-Questionnaire (n= 88)

  10. Sources of financing ART

  11. 2% 3% 4% 8% YES Severe YES Medium 83% YES Light N=114 Could not qualify Pat. Answered with NO Have you ever experienced a financial crisis due to expenses for ART ?

  12. Comparing ARV Naive and ARV Experienced patients at baseline

  13. naive and experienced patients after 3-6mo % % % % P<0.001 N= 237 P=.0023 N= 807

  14. Virological outcomes after 6-12 months of ART (n=158) * OR 6.0, 95% CI 1.8-20.2 , p=0.004

  15. Adherence estimated by pill counts, n=329 88 90 80 70 60 % of patients 50 40 30 20 6 5 10 1 0 95- 90 % adherence, 5-10% pills missed 90-80 % adherence, 10-20% pills missed < 80 % adherence, >20% pills missed Pill Counts November 2005 Lagos Project >95 % adherence, 0-5 % pills missed

  16. Failing ARV-exp.Patientsgenotyping:77 %resistancen=13

  17. Conclusions • User fees for HIV care are unaffordable for PLWHA and contribute to impoverishment • Financial constraints are the most common reason for treatment interruptions in fee-paying patients • Outcomes of treatment among experienced patients on 1st line therapy appear worse than among naives, probably due to ARV resistance

  18. Thank You !

  19. Team at BCCfE in Vancouver, David Tu Els St.-Botha whole team in Lagos Acknowledgements: Daniel O`brien (AMS) Kamalini (AMS) Tom Ellman (London) Wilma (Medco) Francois( HoM) Kai Braker, Berlin Philomina Orji Bernadette Olomo

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