Benefit incidence analysis of HIV services in Enugu State, southeast Nigeria: do the poor preferentially benefit?

BACKGROUND

Nigeria ranks fourth globally in human immunodeficiency virus (HIV) prevalence, with an estimated 1.9 million people living with HIV. HIV response in Nigeria has been largely funded by development partners providing free treatment services at designated health facilities. This study aims to examine the benefit incidence of subsidized HIV services and the distribution of benefits across population groups with different socio-economic status (SES).

METHODS

A survey of patients (n=212) accessing antiretroviral therapy clinics in six purposively selected urban and rural facilities in Enugu State. Principal components analysis was used to create an SES index. The concentration index was used to measure the level of equity in spending across the socio-economic quintiles.

RESULTS

The majority (60%) of respondents visited facilities every 2 months. All respondents received HIV drugs for free. The total monthly gross and net benefits of HIV services were US$2143 and US$1755, respectively. Surveyed respondents obtained the largest benefit through using HIV drugs, which accounted for >56% of gross benefit and almost 70% of net benefit of total HIV services. The concentration indices for gross (-0.03) and net (-0.06) benefits indicate a pro-poor distribution of HIV services.

CONCLUSION

Subsidized HIV services in Enugu State disproportionately benefited poorer populations, with free HIV drugs constituting the largest share of benefits, indicating equitable access to HIV services in Enugu State.