B O Olakunde1, D A Adeyinka2, C E Ozigbu3, T Ogundipe4, W N A Menson5, J O Olawepo6, O A Olakunde7, E E Ezeanolue8. 1. National Agency for the Control of AIDS, Abuja, Nigeria. Electronic address: boolakunde@yahoo.com. 2. Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada; National AIDS & STIs Control Programme, Federal Ministry of Health, Abuja, Nigeria. 3. National AIDS & STIs Control Programme, Federal Ministry of Health, Abuja, Nigeria; Department of Health Services Policy and Management, University of South Carolina, Columbia, USA. 4. Department of Community and Family Medicine, Howard University Hospital, Washington DC, USA. 5. Ghana Health Service, Accra, Ghana. 6. School of Public Health, University of Nevada, Las Vegas, NV, USA; Caritas Nigeria, Abuja, Nigeria. 7. Ondo State Primary Health Care Development Board, Ondo, Nigeria. 8. Department of Pediatrics and Child Health, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria; HealthySunrise Foundation, Las Vegas, NV, USA.
Abstract
OBJECTIVE: The overall increase in global domestic HIV expenditure obscures the specific performances of many sub-Saharan Africa (SSA) countries in local resourcing of their HIV programs. In this study, we explored the pattern and correlates of domestic HIV expenditure in SSA. STUDY DESIGN: This is a cross-sectional ecological study. METHODS: Data were obtained from the Joint United Nations Programme on HIV/AIDS, World Bank, and the World Health Organization. We included 30 countries with available country-reported HIV expenditures between 2012 and 2017. From the most recent data, we examined the domestic (public and private) HIV expenditure as percentage of the total HIV expenditure. Using Spearman's rho, we assessed the correlation between domestic expenditure as percentage of the total HIV expenditure and HIV prevalence, antiretroviral coverage, gross national income (GNI) per capita, domestic general government health expenditure (GGHE-D) as percentage of general government expenditure, and GGHE-D per capita. Significant correlates at bivariate level were included in a multivariate median regression model. RESULTS: The median domestic HIV expenditure as percentage of the total HIV expenditure was 24.9% (interquartile range [IQR]: 8.5-39.3%). In 15 of 30 (50%) countries, domestic HIV expenditure as percentage of the total HIV expenditure was ≤25%. In 23 of 30 (77%) countries, public source accounted for >75% of the domestic HIV expenditure. There was a significant positive correlation between domestic expenditure as percentage of total HIV expenditure and GNI per capita (r = 0.52, P = 0.003) and GGHE-D per capita (r = 0.494, P = 0.005). In the multivariate median regression model, only GNI per capita remained statistically significant (β = 0.006, P = 0.004). CONCLUSIONS: Some countries in SSA are still overly dependent on external support for their HIV response. Although increasing domestic HIV expenditure in these countries may require growth in the economy, governments can improve the fiscal space for HIV response by looking inward for innovative and sustainable funding mechanisms.
OBJECTIVE: The overall increase in global domestic HIV expenditure obscures the specific performances of many sub-Saharan Africa (SSA) countries in local resourcing of their HIV programs. In this study, we explored the pattern and correlates of domestic HIV expenditure in SSA. STUDY DESIGN: This is a cross-sectional ecological study. METHODS: Data were obtained from the Joint United Nations Programme on HIV/AIDS, World Bank, and the World Health Organization. We included 30 countries with available country-reported HIV expenditures between 2012 and 2017. From the most recent data, we examined the domestic (public and private) HIV expenditure as percentage of the total HIV expenditure. Using Spearman's rho, we assessed the correlation between domestic expenditure as percentage of the total HIV expenditure and HIV prevalence, antiretroviral coverage, gross national income (GNI) per capita, domestic general government health expenditure (GGHE-D) as percentage of general government expenditure, and GGHE-D per capita. Significant correlates at bivariate level were included in a multivariate median regression model. RESULTS: The median domestic HIV expenditure as percentage of the total HIV expenditure was 24.9% (interquartile range [IQR]: 8.5-39.3%). In 15 of 30 (50%) countries, domestic HIV expenditure as percentage of the total HIV expenditure was ≤25%. In 23 of 30 (77%) countries, public source accounted for >75% of the domestic HIV expenditure. There was a significant positive correlation between domestic expenditure as percentage of total HIV expenditure and GNI per capita (r = 0.52, P = 0.003) and GGHE-D per capita (r = 0.494, P = 0.005). In the multivariate median regression model, only GNI per capita remained statistically significant (β = 0.006, P = 0.004). CONCLUSIONS: Some countries in SSA are still overly dependent on external support for their HIV response. Although increasing domestic HIV expenditure in these countries may require growth in the economy, governments can improve the fiscal space for HIV response by looking inward for innovative and sustainable funding mechanisms.
Authors: Hellen Musana; Jude Thaddeus Ssensamba; Mary Nakafeero; Henry Mugerwa; Flavia Matovu Kiweewa; David Serwadda; Francis Ssali Journal: AIDS Res Ther Date: 2021-04-21 Impact factor: 2.250
Authors: Joseph B Babigumira; Scott Barnhart; Joanna M Mendelsohn; Vernon Murenje; Mufuta Tshimanga; Christina Mauhy; Isaac Holeman; Sinokuthemba Xaba; Marrianne M Holec; Batsirai Makunike-Chikwinya; Caryl Feldacker Journal: PLoS One Date: 2020-09-30 Impact factor: 3.240