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Economic Burden of Accessing Antiretrovirals Among People Living with HIV; Findings from a Cross-Sectional Survey in Lagos State, Nigeria

Background: HIV/AIDS is one of the major diseases with multifaceted burdens; health, emotional and financial. After the introduction of the Antiretroviral Therapy (ART), HIV/AIDS became a chronic disease that requires long-term management thus competing with other day-to-day economic obligations of People Living with HIV/AIDS (PLWH). There have been limited studies assessing economic burden of accessing ART treatment vis-a-vis catastrophic health expenditure (CHE) in this environment. Therefore, this survey explores the CHE resulting from accessing ART treatment and identifying some of the predictors for CHE among PLWH in Lagos State, Nigeria. Materials and methods: This study was a descriptive cross-sectional, quantitative survey that was carried out among 217 consenting PLWH recruited from 15 Support groups in Lagos State, Nigeria. The data was collected using 29-items self-administered questionnaire (research assistants aided PLWH who cannot read or write) developed from the review of relevant literatures. The data were analyzed using SPSS version 20. Chi-square at p-value of 10% of household consumption,) 40% of the surveyed respondents experienced CHE. Using chi-square to determine factors associated with CHE among respondents; occupation, income group and ARVs refill frequency were significant at P<0.05. However, the binary logistic regression identified formal occupation (aOR=0.025, 95% C.I=0.02-0.35, p-value=0.006), being in middle income group (aOR=0.007, 95% C.I=0.001-0.05, p-value=0.0001) and high income group (aOR=0.035, 95% C.I=0.10-0.12, p-value=0.0001) and visiting health care facility for ARVs refill bi-monthly (aOR=17.555, 95% C.I=4.64-66.40, p-value=0.0001) as predictors of CHE among respondents. Conclusions: The results of this survey revealed that having formal employment, belonging to middle and high income groups protects respondents from CHE while bi-monthly ARVs refill predisposes PLWH in this survey to CHE.