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ABSTRACT

The HIV/AIDS pandemic has resulted in mortality surge and life expectancy drop throughout the world. Developing countries are mostly affected due to their limited health care system and resources to handle the increasing costs of management of HIV/AIDS and associated opportunistic infections. The objective of this study is to estimate direct and indirect costs of managing HIV/AIDS to both the health sector and the patients, at Murtala Muhammad Specialist Hospital, Kano (MMSH). Patients‘ data from a sample of 256 adults and 28 children were collected between 1st January and 31st December 2010. The study revealed that majority of the patients were aged between 15 and 49 (87.7%), female (66.2%) and married (71.48%), while about forty percent were unemployed (39.8%) and 27.1% had an income of less N20,000. The average annual income for the patients was estimated to be N143,796. About half of the respondents had a CD4 count test done once (52.5%), most were on antiretrovirals (94.37%), a few had co-morbid illnesses (12.32%), side effects/adverse drug reactions (10.9%), hospitalized (11.27%) or had National Health Insurance Scheme (NHIS) coverage(3.87%). The estimated average total annual costs to the health sector and patients were N323,303 and N10,516 respectively. Major contributors to health sector costs which were all direct-medical costs were antiretroviral drugs (83.60%) and health care personnel (12.37%). Direct-medical costs to patients amounted to about N3,055 (2.12%) with major contributions from hospitalisation , treatment of co-morbid illnesses and laboratory tests. Direct non-medical and indirect costs to patients were derived from transport (N2,634, 1.83%) and productivity loss (N4,827; 3.36%) respectively, the total patients cost of N10,516 amounted to 7.31% of their average annual income of N143,796. Thus, data obtained suggested that the management of HIV/AIDS at MMSH poses a serious economic burden on the health care system and on patients living with the disease. Majority of the health care costs (antiretrovirals) were provided by Non Governmental Organisations (NGOs); this scenario applies all over the country. In the event that the NGOs withdraw their aid in the future, the burden to the health sector may be too much for the Government to bear. The expansion of the NHIS to include HIV/AIDS management will decrease the burden on the Government and the patients. Increasing efforts on HIV infection prevention should also significantly decrease the burden of HIV/AIDS in the long run.

Introduction

Ill-health can result in an increase in economic burden on individuals, contributing to income loss, asset depletion as well as investment of a large amount of National resources to combating that disease. These processes are brought into sharper focus by the social and economic impact of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. Concern about the links between ill-health and impoverishment has placed health at the centre of development agencies‘ poverty reduction targets and strategies. This has strengthened arguments for a substantial increase in health sector investment to improve access for the world‘s poorest people to combat poverty as well as reduce disease burden (Russel, 2004). This thesis reports on an evaluation of costs committed to HIV/AIDS management in a secondary health facility, (MMSH) in Kano, Nigeria.

1.2 Statement of Research Problem

The HIV/AIDS pandemic constitutes one of the greatest health challenges of our time (IBBSS, 2008) and its impact cannot be overemphasized. HIV has added to the burden of the already over-stretched health care infrastructure in Nigeria as well as increased the number of orphans and other vulnerable children, placing additional strain on family and community support structures (FMOH, 2008).

With the growth rate (2%) and burden of illness, it is important for us to know the impact of HIV/AIDS management on health systems, individuals and societies as well as a description and analysis – a measure of the cost of illness (COI), which is a major tool in pharmacoeonomics. According to CDC (2009), COI is defined as the value of the resources that are expended or foregone as a result of a health problem. The COI includes health sector costs, the value of lost productivity by the patient (indirect cost), and the cost of pain and suffering (intangible costs) (CDC, 2009).