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ABDULRAHMAN, Fatima Manzuma


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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 aboutN3,055 (2.12%) with major
contributions from hospitalisation , treatment of co-morbid illnesses and laboratory
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.


Title Page——————————————————————————————-ii
Table of Contents——————————————————————————–viii
List of Tables————————————————————————————-xii
List of Figures————————————————————————————xiii
List of Appendices——————————————————————————-xiv
1.1 About this Study——————————————————————————-1
1.2 Statement of Research Problem————————————————————-1
1.3 Justification for the Study——————————————————————–2
1.4 Theoretical Framework———————————————————————–3
1.5Aim and Objective of the Study————————————————————–4
1.6 Statement of Research Hypothesis———————————————————-4
2.1 Overview of HIV/AIDS———————————————————————-5
2.1.1 HIV/AIDs Timeline————————————————————————-7
2.1.2 Method of Transmission of HIV/AIDS ————————————————12
2.1.3 Impact of HIV/AIDS———————————————————————-14
2.1.4 Factors Militating Against Accessing ART and HIV Care————————–18
2.1.5 HIV Treatment in Nigeria —————————————————————19
2.1.6 Funding for HIV/AIDS——————————————————————-23
2.2 Epidemiology of HIV/AIDS—————————————————————-25
2.2.1 Global Epidemiology of HIV/AIDS—————————————————-25
2.2.2 Epidemiology, Africa———————————————————————27
2.2.3 Epidemiology, Nigeria——————————————————————–28
2.3 Pharmacoeconomics ————————————————————————29
2.3.1 Cost-Effectiveness Analysis————————————————————–30
2.3.2 Cost-Minimization Analysis————————————————————-30
2.3.3 Cost-Benefit Analysis———————————————————————31
2.3.4 Cost-Utility Analysis———————————————————————-31
2.4 Cost of Illness Analysis ——————————————————————–33
3.1 Methodology———————————————————————————-35
3.1.1 Study Hospital——————————————————————————35
3.1.2 Study Perspective————————————————————————–35
3.1.3 Study Design——————————————————————————-35
3.1.4 Study Population—————————————————————————35
3.1.5 Study Period——————————————————————————–36
3.1.6 Data Source———————————————————————————36
3.1.7 Sample Size Determination————————————————————–37
3.1.8 Statistical Analysis and Data Presentation———————————————37
3.1.9 Pharmacoeconomic Method————————————————————–38
3.2 Limitation of Study————————————————————————–38
4.1 Clinic Population and Clinic Days———————————————————39
4.2 Patients Bio Data —————————————————————————39
4.2.1 Age——————————————————————————————39
4.2.2 Sex——————————————————————————————-39
4.2.3 Education———————————————————————————–41
4.2.4 Marital Status——————————————————————————-41
4.2.5 Education———————————————————————————–41
4.2.6 Income————————————————————————————–41
4.2.7 Household Size—————————————————————————–41
4.2.8 Financial Sponsor————————————————————————–45
4.3 Medical History——————————————————————————45
4.3.1 Diagnostic Tests —————————————————————————45
4.3.2 Treatment Category———————————————————————–45
4.3.3 Co-morbid Illnesses———————————————————————–45
4.3.4 Self-medication—————————————————————————-49
4.3.5 Side Effects/Adverse drug Reaction—————————————————-49
4.3.6 Emergency Room Visits——————————————————————49
4.3.7 Hospitalisation—————————————————————————–49
4.3.8 Alternate Source of Care——————————————————————49
4.4 Costs——————————————————————————————-52
4.4.1 Transport Cost to the Hospital———————————————————–52
4.4.2 Cost Contribution of Health Care Personnel——————————————-52
4.4.3 Cost Contribution of Laboratory Investigations—————————————52
4.4.4 Cost of Drugs——————————————————————————-57
4.4.5 Productivity Losses————————————————————————64
4.4.6 Estimated Contribution of Costs to Health Care Workers and the Patients——–64
6.1 Summary————————————————————————————–77
6.2 Conclusion————————————————————————————77
6.3 Recommendation—————————————————————————–78


1.1 About the study
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).
HIV infection is a major public health problem in all parts of the world. For the United
States, federal spending on HIV disease for 1982 to 1989 was $US5.5 billion.
Projections indicate that AIDS spending may reach 1.6% of total health expenditures in
1992, while the indirect costs of HIV infection may be 5 times as great as the direct
costs (Lynn et al., 1992). The reported official development assistance for HIV to
Nigeria between 2001 and 2008 is $US989.14 million (NASA, 2008). In the
developing countries, the cost per person with HIV infection may be 0.8 to 9-fold
greater than the per capita gross national product (GNP), this would confer some
burden to the economy.
1.3 Justification for the Study
Poverty, an issue in Sub-Saharan Africa, exacerbates the impact of HIV and AIDS.
Food insecurity also weakens the beneficial effects of medicine, while caring for the
sick and those orphaned or widowed by AIDS stretches families’ resources to their
limits. HIV/AIDS continues to devastate the African region, which has 11% of the
world’s population, but 60% of the people with HIV/AIDS. Although HIV/AIDS
remains the leading cause of death for adults, more and more people are receiving life
saving treatment. The number of HIV-positive people on antiretroviral medicines
increased eight-fold, from 100 000 in December 2003 to 810 000 in December 2005
(WHO, 2009). These epidemiological data help determine a nation‘s current health
profile and systems and also identify the effectiveness of available technologies in
eliminating these problems.
The African Regional Health Report (2009), stresses that Africa can move forward on
recent progress only by strengthening its fragile health systems. To achieve this, it
would need to make informed choices on which health problems to address and what
interventions to use to alleviate them hence, knowledge of the economic burdens of the
various health problems is important. A major drawback to carrying out these
evaluations in Africa is the already limited resources to the health sector.
1.4 Theoretical Framework
The compilation of COI estimates for HIV/AIDS management can be challenging and
complex, however, the framework for the study is adapted from previously carried out
studies. The design and performance of these studies need to be built around a set of
objectives and standards that have scientific validity and can be communicated to the
concerned scientific community, policy makers and the general population. The
framework as outlined by Segel (2006) includes the following:
Estimate costs which include:
I. Direct-medical costs which include cost of drugs, hospitalization, emergency
visits, managing co-morbid illnesses, side effects/adverse drug reactions
II. Direct non-medical costs which include transport and
III. Indirect costs which include productivity losses (Segel, 2006; Mauch, 2008).
Individuals suffering from HIV/AIDS cuts across all ages but most of them are often in
their economically most productive age, this poses a significant economic burden on
the household and community as well as on the health workers if the number is
significant as well as if health workers are affected by the illness. This study is in a
hospital mostly accessed by non affluent individuals hence the costs as a percentage of
their income may be higher than for non-poor patients. Out-of-pocket costs for public
and private health-care services may also exacerbate burden on the already non
financially buoyant people. Stratification of patients along several indicators (gender,
geography, socioeconomic status) is therefore necessary (Mauch, 2008).
Accomplishing these steps can require significant time, resources, and skill, but
keeping these objectives and questions in mind during the course of the study should
facilitate the effort and ultimately make the final estimate more accurate.
1.5 Aim and Objective of the Study
1.5.1 Aim of the study
The aim of this study is to determine the economic burden of management of
HIV/AIDS patients at the Murtala Mohammed Specialist Hospital Kano, Nigeria.
1.5.2 Specific Objectives of the Study
I. To determine the direct and indirect components of COI of HIV/AIDS on the
health care sector
II. To determine the direct and indirect components of the COI of HIV/AIDS of
1.6 Statement of Research Hypothesis
Management of HIV/AIDS at the Murtala Mohammed Specialist Hospital, Kano,
Nigeria has no economic burden on the health care system and on the patients.


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