Effect of PEPFAR funding policy change on HIV service delivery in a large HIV care and treatment network in Nigeria.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
11
01
2019
accepted:
15
08
2019
entrez:
26
9
2019
pubmed:
26
9
2019
medline:
10
3
2020
Statut:
epublish
Résumé
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.
Identifiants
pubmed: 31553735
doi: 10.1371/journal.pone.0221809
pii: PONE-D-19-00910
pmc: PMC6760763
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0221809Subventions
Organisme : NIMH NIH HHS
ID : K01 MH107255
Pays : United States
Organisme : NIAID NIH HHS
ID : K23 AI106406
Pays : United States
Organisme : NIAID NIH HHS
ID : R01 AI058736
Pays : United States
Organisme : NIAID NIH HHS
ID : R37 AI058736
Pays : United States
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
N Engl J Med. 2013 Oct 10;369(15):1385-7
pubmed: 24106930
J Acquir Immune Defic Syndr. 2014 Mar 1;65(3):247-50
pubmed: 24346642
Clin Infect Dis. 2005 Jul 15;41(2):217-24
pubmed: 15983918
Glob Health Sci Pract. 2015 Jun 17;3(2):274-86
pubmed: 26085023
Clin Infect Dis. 2011 Dec;53(12):1283-90
pubmed: 22080121
AIDS Care. 2018 Apr;30(4):453-460
pubmed: 29067861
Global Health. 2013 Oct 25;9:52
pubmed: 24160182
AIDS Care. 2015;27(10):1298-303
pubmed: 26300297
AIDS. 2012 Jun 19;26(10):1303-10
pubmed: 22706012
AIDS. 2008 Jul;22 Suppl 1:S95-101
pubmed: 18664961
PLoS Med. 2011 Jan 18;8(1):e1000391
pubmed: 21267059
BMC Infect Dis. 2011 Sep 30;11:258
pubmed: 21957868
BMC Health Serv Res. 2012 Nov 24;12:427
pubmed: 23176556
AIDS. 2008 Oct 1;22(15):1971-7
pubmed: 18784460
J Glob Health. 2016 Jun;6(1):010407
pubmed: 27231543
Bull World Health Organ. 2008 Jul;86(7):559-67
pubmed: 18670668
Viral Immunol. 2006 Winter;19(4):759-67
pubmed: 17201671
AIDS. 2006 Jun 12;20(9):1333-6
pubmed: 16816566
AIDS. 2008 Jul;22 Suppl 1:S161-8
pubmed: 18664948
Pan Afr Med J. 2016 Nov 11;25:143
pubmed: 28292105
Curr Opin HIV AIDS. 2015 Nov;10(6):451-63
pubmed: 26371461
J Acquir Immune Defic Syndr. 2010 Mar;53(3):405-11
pubmed: 19745753
J Int AIDS Soc. 2011 Jun 16;14:32
pubmed: 21679416
AIDS. 2005 Oct 14;19(15):1643-7
pubmed: 16184034
Curr Opin HIV AIDS. 2010 Jan;5(1):18-26
pubmed: 20046144
JAMA Intern Med. 2017 Aug 1;177(8):1083-1092
pubmed: 28628702