Abstract:

Availability and accessibility of essential medicines for HIV recipients of care varies across regions in Nigeria. This study seeks to compare access and availability of medicines for HIV in the South south and Northeast regions of Nigeria. Data were collected from 120 health facilities and 385 respondents using structured questionnaires and analysed using descriptive statistics and thematic analysis. The study methodology included an exploratory sequential mixed of quantitative and qualitative methods, including facility assessments, in-depth interviews, client satisfactory questionnaire conducted amongst HIV program stakeholders and HIV recipients of care. The study found that the HIV program in the regions have made progress in improving the accessibility of essential medicines for HIV patients. The North-East had an average access rate of 87.1%, while the South-South had a slightly higher average access rate of 85.6%. The North-East had a prescription rate of 100% for antiretroviral therapy (ART) for adolescents and for the preventive treatment for tuberculosis (INH + Pyridoxine). On the other hand, access to micronutrient supplementation was higher in the South-South region at 94.7%, compared to the North-East region with a rate of 74.2%. In conclusion, this study highlights that the availability of essential medicines such as ART drugs, micronutrients and prophylaxis for opportunistic infections, medicine supply, storage and documentation has improved overtime with support from donor agencies, though still challenged with electronic management systems and need for adequate procurement, quantification, additional technical assistance, funding and supply chain infrastructure is recommended to be addressed towards achievement of HIV epidemic control in Nigeria.

References:

[1] Adewole, O. F., et al. (2021). Nigeria HIV/AIDS Indicator and Impact Survey 2018: Summary Sheet. Federal Ministry of Health, National Agency for the Control of AIDS. http://naca.gov.ng/wp-content/uploads/2021/07/Nigeria-HIV-AIDS-Indicator-and-Impact-Survey-NAIIS-2018-Summary-Sheet.pdf.

[2] Rabkin, M., Melaku, Z., Bruce, K., Reja, A., Koler, A., Tadesse, Y., Kamiru, H. N., Sibanyoni, L. T., & El-Sadr, W. (2012). Strengthening Health Systems for Chronic Care: Leveraging HIV Programs to Support Diabetes Services in Ethiopia and Swaziland. Journal of Tropical Medicine, 2012. https://doi.org/10.1155/2012/137460.

[3] Otu A., Charles CH, Ani F., et al. HIV prevalence and associated risk factors among individuals aged 15–49 in North-Eastern Nigeria. BMC Public Health. 2020;20(1):405. doi:10.1186/s12889-020-08530-5.

[4] Inyang US, Okonkwo PI, Essien EJ, Udoma EJ, Ekanem E. Assessment of the impact of insurgency on the delivery of HIV/AIDS services in North-east Nigeria. Journal of Public Health in Africa. 2018;9(1):746. doi:10.4081/jphia.2018.746.

[5] Aregbeshola, B. S. (2021). Towards Health System Strengthening: A Review of the Nigerian Health System From 1960 to 2019. SSRN Electronic Journal. https://doi.org/10.2139/SSRN.3766017.

[6] Ahmad, A., Samer, E., Jessica, B., Bruce, A., Nicaise, N., Gambo, A., Jibreel, J., Babatunde, A., Patrick, D., Alash’le, A., & Manhattan, C. (2019). Performance and trend for quality of service in a large HIV/AIDS treatment program in Nigeria. AIDS Research and Therapy, 16–29.

[7] World Health Organization. (2019). Global Health Expenditure Database. Retrieved from https://apps.who.int/nha/database/Home/Index/en.

[8] Adoyo, Maureen. (2020). Landscape analysis of healthcare policy: the instrumental role of governance in HIV/AIDS services integration framework. Pan African Medical Journal. 36. 10.11604/pamj.2020.36.27.22795.

[9] Olutuase, V.O., Iwu-Jaja, C.J., Akuoko, C.P. et al. Medicines and vaccines supply chains challenges in Nigeria: a scoping review. BMC Public Health 22, 11 (2022). https://doi.org/10.1186/s12889-021-12361-9.

[10] Murray, S. B., & Crawford-Faucher, A. C. (2022). Antiretroviral therapy for HIV infection: Overview. American Family Physician, 105(3), 311-320.

[11] World Health Organization. (2021). Antiretroviral therapy. https://www.who.int/news-room/questions-and-answers/item/antiretroviral-therapy.

[12] Centers for Disease Control and Prevention. (2021). HIV/AIDS treatment & prevention. https://www.cdc.gov/hiv/basics/index.html.

[13] United Nations Programme on HIV/AIDS. (2021). Essential medicines for HIV/AIDS. https://www.unaids.org/en/topic/essential-medicines.

[14] National Institutes of Health. (2021). HIV treatment and prevention. https://www.niaid.nih.gov/diseases-conditions/hiv-treatment-prevention.

[15] El-Sadr, W. M., & Justman, J. (2018). Access to antiretroviral therapy in Africa: Sustaining and strengthening. Current HIV/AIDS Reports, 15(2), 127-136.

[16] Adewuyi, E. O., & Ajumobi, O. (2019). Strengthening health systems to support HIV and AIDS prevention and control: A critical review of the research literature. BMC Health Services Research, 19(1), 172.

[17] Okeke, C. O., Uzochukwu, B. S., Okafor, H. U., Ani, O. E., & Isaac, A. B. (2017). Availability, stock-outs and dispensing practices of essential medicines in Nigeria: A qualitative study in rural and urban pharmacy outlets. Health Policy and Planning, 32(5), 705-713.

[18] Farge, E., Barasa, E., Waitolo, J., Winters, T., & Chuma, J. (2020). Evaluating global health partnerships: A case study of a Gavi HPV vaccine application process in Uganda. Global Public Health, 15(4), 563-575.

[19] Mbengashe, N. S., Brown, H. L., Njoroge, B., Omondi, A., & van der Straten, A. (2020). Antiretroviral therapy and the use of contraception among HIV-positive women in western Kenya. Journal of Women’s Health, 29(2), 189-195.

[20] Sheikh, K., Gilson, L., & Agyepong, I. A. (2011). Building the field of health policy and systems research: An agenda for action. Plos Medicine, 8(8), e1001081.

[21] Okeke, C. O., Uzochukwu, B. S., & Okafor, H. U. (2018). An evaluation of the supply chain management of essential medicines in Nigeria. Public Health, 161, 1-8.

[22] Tavrow, P., Kim, Y. M., & Malianga, L. (2009). Measuring the quality of supervisor-provider interactions in health care facilities in Zimbabwe. International Journal for Quality in Health Care, 21(5), 315-322.

[23] Decroo, T., Rasschaert, F., Telfer, B., Remartinez, D., Laga, M., Ford, N., & MacPherson, P. (2014). Community-based antiretroviral therapy programs can overcome barriers to retention of patients and decongest health services in sub-Saharan Africa: a systematic review. International Health, 6(4), 210-226.

[24] Ogbuabor DC, Onwujekwe OE, Okoronkwo I, Uzochukwu BS. Community ART groups as an intervention to improve retention in care among patients on ART in Nigeria: a pilot study. BMC Public Health. 2018;18(1):946. doi:10.1186/s12889-018-5852-6.

[25] Grimsrud, A., Bygrave, H., Doherty, M., Ehrenkranz, P., Ellman, T., Ferris, R., Ford, N., Killingo, B., Kruger, J., Lee, J., Mamvura, C., Mansoor, L., Maruva, M., Mohapi, L., Mohammed, S., Moyo, S., Ncube, K., & Phillips, A. (2016). Reimagining HIV service delivery: the role of differentiated care from prevention to suppression. Journal of the International AIDS Society, 19(1), 21484.