Determinants of demand for anti retroviral (ARV) drugs in Uganda: a case study of Wakiso District

Abstract

The research was motivated by the low ARV demand response following the introduction of generic ARV drugs which lead to a cost reduction in Uganda’s adopted first line ARV treatment (AZT+D4T+NVP) from US$ 456 per month in 2001 to US$ 30 in 2003. With such dramatic fall in the ARV costs, only 10% of the 100,000 ARV eligible patients had access to ARVs. The question then became, “besides price, what else is determining ARV demand?” A field clinical-based survey was conducted with demand for ARVs assumed to be dependent on the price of ARVs and monitoring tests, total expenditure on health care, goods and services, formal education, employment, residential status and proximity to ARV care unit. The findings indicate that affordability of ARVs and CD4 and Viral Load monitoring tests, and being formally educated increased access to ARVs according to the Pearson chi-square at the 1% level of significance. Access to ARVs was also not independent of formal employment, residence, sponsorship status and proximity to care according to the Pearson chi-square at the 5% level of significance. The odds of accessing ARVs increased with an increase in the price of ARVs, monitoring test costs and formal education according to the logit at the 1% level of significance. While ARV price reductions should be secured through increased ARV local supply, test costs should be reduced through the direct observed therapy strategy. Awareness on ARV among the low educated patients should be raised. Access to ARVs among the informal workers should be improved through public-private cost sharing. A” Work for Medicine” initiative should be instituted for patients without sponsorship for ARVs. While Village Health Teams should identify and recommend for treatment the homeless patients, ARV mobile clinics for patients not within easy reach of services are recommended.