Effect of PEPFAR funding policy change on HIV service delivery in a large HIV care and treatment network in Nigeria


Autoři: Bolanle Banigbe aff001;  Carolyn M. Audet aff002;  Prosper Okonkwo aff001;  Olujide O. Arije aff005;  Elizabeth Bassi aff001;  Kate Clouse aff002;  Melynda Simmons aff002;  Muktar H. Aliyu aff002;  Kenneth A. Freedberg aff007;  Aima A. Ahonkhai aff002
Působiště autorů: APIN Public Health Initiatives (APIN), Abuja, Nigeria aff001;  Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America aff002;  Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America aff003;  Friends in Global Health, Maputo, Mozambique aff004;  Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria aff005;  Division of Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America aff006;  Division of Infectious Disease and General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America aff007;  Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America aff008;  Harvard Medical School, Boston, Massachusetts, United States of America aff009;  Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America aff010;  Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America aff011
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0221809

Souhrn

The transition to PEPFAR 2.0 with its focus on country ownership was accompanied by substantial funding cuts. We describe the impact of this transition on HIV care in a large network of HIV clinics in Nigeria. We surveyed 30 comprehensive HIV treatment clinics to assess services supported before (October 2013-September 2014) and after (October 2014-September 2015) the PEPFAR funding policy change, the impact of these policy changes on service delivery areas, and response of clinics to the change. We compared differences in support for staffing, laboratory services, and clinical operations pre- and post-policy change using paired t-tests. We used framework analysis to assess answers to open ended questions describing responses to the policy change. Most sites (83%, n = 25) completed the survey. The majority were public (60%, n = 15) and secondary (68%, n = 17) facilities. Clinics had a median of 989 patients in care (IQR: 543–3326). All clinics continued to receive support for first and second line antiretrovirals and CD4 testing after the policy change, while no clinics received support for other routine drug monitoring labs. We found statistically significant reductions in support for viral load testing, staff employment, defaulter tracking, and prevention services (92% vs. 64%, p = 0.02; 80% vs. 20%, 100% vs. 44%, 84% vs. 16%, respectively, p<0.01 for all) after the policy change. Service delivery was hampered by interrupted laboratory services and reduced wages and staff positions leading to reduced provider morale, and compromised quality of care. Almost all sites (96%) introduced user fees to address funding shortages. Clinics in Nigeria are experiencing major challenges in providing routine HIV services as a result of PEPFAR’s policy changes. Funding cutbacks have been associated with compromised quality of care, staff shortages, and reliance on fee-based care for historically free services. Sustainable HIV services funding models are urgently needed.

Klíčová slova:

Antiretroviral therapy – Government funding of science – Health care policy – HIV – HIV diagnosis and management – Nigeria – Clinical laboratories – Government laboratories


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