ArticlePloS one2020
The impact of user fees on uptake of HIV services and adherence to HIV treatment: Findings from a large HIV program in Nigeria.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.
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Who cites it
8 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Free antiretrovirals as a key tool against the HIV pandemic: A systematic review.HIV medicine · 2025Pooled it
- Retention in Care Among People Living with HIV in Nigeria: A Systematic Review and Meta-analysis.Journal of research in health sciences · 2024Pooled it
- Laboratory test availability and user fees in routine HIV care: a global analysis in 42 countries.Health affairs scholar · 2026Article
- Limited user fees for adult HIV diagnosis and routine laboratory monitoring in the global IeDEA consortium: analysis in 42 countries.medRxiv : the preprint server for health sciences · 2025Article
- COVID-19 self-testing in Nigeria: Stakeholders' opinions and perspectives on its value for case detection.PloS one · 2023Article
- Differentiated service delivery models among PLHIV in Akwa Ibom and Cross River States, Nigeria during the COVID-19 pandemic: descriptive analysis of programmatic data.Journal of the International AIDS Society · 2021Article
- Distribution of antiretroviral therapy through private pharmacies and postal courier services during COVID-19 in Botswana: acceptability and reach of two out-of-facility individual differentiated service delivery models.Journal of the International AIDS Society · 2021Article
- Adaptation of evidence-based approaches to promote HIV testing and treatment engagement among high-risk Nigerian youth.PloS one · 2021Article
Corrections and comments
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Authors and funding
11 authors.
Funding
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%, p<0.001). Compared to pre-fee patients, the post-fee period had a 48% decreased risk of care interruption (aRR = 0.52, 95%CI:0.39-0.69), 22% decreased LTFU risk (aRR = 0.64, 95%CI:0.96), and 27% decreased odds of optimal medication adherence (aOR = 0.7, 3 95%CI 0.59-0.89).
conclusionsPatients 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.
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