Treatment-Seeking Practices and the Willingness to Pay for Antiretroviral treatment of HIV-Positive Patients in Southeast Nigeria

Introduction: Increasing the coverage and sustaining antiretroviral therapy (ART) in Nigeria will lead to an increase in costs meaning that user fees may need to be increased. Also, provision and utilization of ART services can only be brought into balance if there is an understanding of the people's health seeking behaviour. Objectives: To determine the use of different health care providers for the diagnosis and treatment of HIV and the willingness to pay (WTP) for own ART and others (altruism). Methods: A cross-sectional questionnaire survey was conducted. WTP was elicited from respondents using the bidding game and the structured haggling technique from 150 randomly selected HIV-positive patients. Results: More respondents used private health facilities. There was a high WTP for and be on ART but very low WTP for altruism. The amounts respondents were willing to pay for their own therapy was 5,000 to 100,000 naira (38.5 - 770 US dollars) annually, mean, 42,000 naira (323 US dollars) and for altruism, 1,500 to 8,500 naira annually (11.5 - 65.4 US dollars), mean 4,800 naira (37 US dollars). Education, income and marital status were positively and significantly correlated with WTP while being a female and/or having tuberculosis negatively affected WTP. More respondents were willing to pay for drugs than tests. Conclusion: Most HIV-positive patients are willing to pay for ART drugs more than tests, but altruism is very low. Any attempt to set drug prices in public health facilities should take the mean WTP amount into consideration. Community financing for ART through altruism should be explored; while private health facilities should be involved in ART programs