Assessment of willingness to pay for antiretroviral treatment among patients attending HIV clinics in Kumi District
Musiitwa, Michael Mugwanya
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Introduction Sustainability and improved access for antiretroviral care over time is uncertain due to its dependency on donor funding whose continuity is uncertain. A study was to assess the willingness of PLWHA to pay for ART care as one of the possible ways of funding ART care was conducted in a rural district. Methods A three-bid contingent valuation study was conducted to assess the willingness to pay (WTP) for ART care and its associated factors among 384 clients attending HIV clinics in Kumi district. Focus group discussions were also used to assess the perceptions of PLWHA towards payment for ART care. Data was analysed in proportions of respondents willing to pay and amounts of money they were willing to pay for the different ART care packages. Factors associated with willingness to pay were determined using logistic regression. Results Overall, very few individuals (< 4%) expressed their willingness to pay for any ART care package at its actual cost. WTP increased with a proportional reduction in amount to be paid reaching a maximum of 16.4% with a 75% reduction in costs for pre-tests. Conversely, a hypothetical increase in the actual cost of care by 25-75% had negative consequences with none of the participants willing to pay for drugs, 0.5% for follow up tests and 1% for pretests. On average, of the 384 respondents 66.4% were willing to pay for pre-tests, 54.4 % for drugs and 54.4% for follow up tests. In relation to pretests, factors that increased WTP included; reporting primary (aOR= 2.09, CI=1.08-4.03) transport cost (aOR =2.15, CI=1.166-3.959), spending less time at the ART clinic (aOR = 233, CI= 37.79-1440.21) and having a possibility of borrowing for ART acquisition (aOR= 4.41, CI=2.33-8.36]. Factors against WTP for preliminary tests were using a vehicle as a means of transport (aOR =0.195, CI=0.07-0.59) and providing improved privacy (aOR = 0.61, CI= 0.016-0.230). In relation to drugs, factors that favored WTP were Secondary level education (aOR of 2.62, CI: 1.02-6.73), tertiary level education (aOR=17.72, CI=1.51-207.46), treatment supporter being and NGO (aOR=15.03, CI=3.18-70.97), spending less time at the ART clinic (aOR of 17.49, CI=4.18-73.21) and having a possibility of borrowing money for ART acquisition (aOR=4.34, CI=2.42-7.76). Factors against WTP for drugs were having been sickly over the previous six months (aOR=0.31 CI=0.17-0.58), using a vehicle as a means of transport (aOR 0.236, CI=0.07-0.75) and improved privacy (aOR 0.143, CI=0.041-0.50). Factors that increased WTP for follow-up tests were; secondary level education (aOR=2.69, CI=1.01-7.14), tertiary education (aOR=29.18, CI=3.12-274.12), treatment supporter being an NGO (aOR=45.98, CI=5.71-370.16), distance to the health facility (aOR=2.18, CI=1.09-4.39), spending less time at the ART clinic (aOR=5.60, CI=2.36-13.26), reducing time at the Health facility (aOR=2.78, CI=1.12-6.86), and a possibility of borrowing for ART acquisition (aOR=3.81, CI=2.09-6.95). Factors against WTP for follow-up tests were; being sickly over the previous six months (aOR=0.37 CI=0.20-0.70), knowledge of ART limitations (aOR=0.10, CI=0.01-0.96) and using a vehicle as a means of transport (aOR=0.27, CI=0.08-0.96) Conclusion The study indicates that much as the majority of the respondents were willing to pay for ART, very few were willing to pay the actual cost of the services. WTP increased with reduction in amount to be paid which indicated that subsidies or cost sharing would improve WTP as well as addressing the factors associated with WTP for each package of ART care.