Over 25,000 persons living with HIV unable access to ' free' life- saving treatment
• CMD justifies changes, appeals for patients' understanding • Hospital says only 6,800 of registered 22,000 persons living with HIV are actively on programme currently
OVER 25,000 persons living with HIV ( PLWHIV) receiving treatment at the Lagos University Teaching Hospital ( LUTH), Idi- Araba, are facing financial hardship due to a recently introduced policy that imposes new fees.
According to a two- page document obtained by The Guardian, provided by publicity secretary of the Network of People Living with HIV and AIDS in Nigeria ( NEPWHAN) in Lagos, Mr. Salisu Ahmed, the new hospital policies, implemented in November 2023, require patients to obtain a new hospital card ( e- card) at a cost of N6,100, regardless of their family size.
The statement further details a bi- annual chemistry test fee of N5,000 per person, adding that a proposed service charge ranging from N3,250 to N2,400 has heightened financial strain on already stretched budgets.
It read: “A memo was sent to the Director of antiretroviral services in LUTH that, starting January 1st 2024, that beginning from the first day of January 2024, all the patients are expected to get ( obtain) the new hospital card ( that is e- card) at the cost of N6,100 and this applies to all patients irrespective of their numbers in one family.
"This is in addition to the N5,000 fee for chemistry ( bleeding) twice a year which is N10,000 per head. This makes it even more unbearable for a family of five ( family, mother and three children) N6,100 x five, plus 5, 000 for the biannual chemistry bleeding of another 10, 000 x five."
It further stated that LUTH management is also considering the implementation of a service charge ranging from N3,250 to N2,400, to be paid by patients during clinic visits to see a doctor or collect medications. The patients argued that these policies are illtimed and exacerbate the already challenging economic climate in the country.
"Our investigation reveals that the Chief Medical Director claimed he pays N105 million monthly for electricity bills. All pleas to adjust this mammoth fee fell on deaf ears as the CMD threatened to seize the electricity supply to the HIV clinic in LUTH," he said. Salisu who is also the chairman of The LUTH CARE Group called on prominent figures, including President Bola Ahmed Tinubu, Minister for Health and Social Welfare, Prof. Ali Mohammed Pate, House of Reps member, Tajudeen Ahmed, and the Director- General of the Centre for Disease Control in Nigeria/ Africa, to intervene urgently, stating: “There is hardship already in the land, and it is just like rubbing salt on our injury all over again.”
He also urged global organisations such as United States Agency for International Development ( USAID), Joint United Nations Programme on AIDS ( UNAIDS), National Agency for Control of AIDS ( NACA), Lagos State Agency for Control of AIDS ( LASACA), and other Non- Governmental Organisations ( NGOS) specialising in HIV/ AIDS to intervene promptly, emphasising the threat to Nigeria's commitment to achieving the 95— 95- 95 goal and ending AIDS by 2030. The persons with HIV further argued that the manipulation of free treatment and care, declared by the Global Fund in 2004, should not compromise the nation's efforts in the fight against HIV/ AIDS.
In response to these challenges, patients are planning a "Treatment Strike" on January 20, 2024, unless their concerns are urgently addressed, which they fear may lead to the termination of their lives.
Speaking in a phone interview with The Guardian, the Chief Medical Director ( CMD) of LUTH, Wasiu Adeyemo, acknowledged the patients' financial concerns but emphasised the hospital's struggle to stay afloat under mounting operational costs.
"If we look at what other people pay in hospitals, it's quite different," the CMD stated. "They haven't been paying, and it's no more realistic. We need money to pay for electricity. We took time with the head of the HIV program and discussed with them over a period of 3- 4 months."
Justifying the new fees, the CMD highlighted the exorbitant electrical bills of N105 million per month, along with other essential expenses. He compared LUTH'S fees to those of other healthcare institutions, affirming that the previous system was unsustainable.
However, Adeyemo, who is a professor of oral and maxillofacial surgery, assured patients that their medication would remain free. The new fees, he explained, primarily cover administrative costs such as the implementation of an electronic medical record system and the issuance of hospital e- cards.
He added that anyone willing to pay for another patient's fees is welcome, while also stating that all patients must bear some responsibility for the hospital's sustainability.
"We discussed this with the coordinator of the program," the CMD emphasised. "We didn't just push it on them. It was an extensive discussion. We need to survive in the hospital. We need to pay for electricity and other things."
Drawing a parallel with other healthcare institutions facing similar financial challenges, Adeyemo implored patients to understand the hospital's precarious position.
"As Nigerians," he urged, "they do not have to kill this system. Some of them have funding issues. It's not sustainable. Do they want to come to the clinic and not have light? Do they want to come to the clinic and not have water? Do they want to come to the clinic and not have basic amenities? Where do they think we are getting the money from? They need to take that responsibility. It has not been easy for us, and it's not only in LUTH."
Coordinator of HIV programme in LUTH, Prof. Sulaimon Akanmu, also offered additional insights that shed light on the rationale behind the changes where he provided historical context.
Akanmu reiterates that the core HIV treatment remains free, with medication and essential tests like viral load assays and CD4 cell counts covered by the programme. However, he clarifies that two crucial elements have seen funding shifts.
"The truth is that the HIV programme is free, and it remains free because the drug they collect from there is free. Some of the tests that they are doing are also free. There are two categories of tests that are done there. The first category is the test to show that the medication they are taking is doing the work it's expected to be doing and then there's another group of tests that is supposed to tell us whether the drug is going to lead to some side effects or not.
“So, there are those tests that we call tests of efficacy of the medication, and they are those that we call tests of safety of the medication. So, the test for efficacy of the medication, which is essentially viral load assay that we do every six months and CD4 cell count that we do at the beginning of the test and when they fall sick, those two tests are paid for by the programme but the test that is required to determine safety of medication; safety of the medication on the liver, safety of the medication on the bone marrow and safety of the medication on the kidney, these tests since 2013 are no longer being paid for by the programme.
"When a patient comes to the hospital, to access care, there are what we call consultation fees. For you to sit down before a nurse, for you to sit down before a doctor, to receive services, there are always consultation fees. This fee was being paid for by the programme, up until 2013.
"In 2013, the programme stopped paying for consultation fees. They said hospitals should take that responsibility and other hospitals have been charging these consultation fees, or what they call access fees, or whatever name they want to give it, but LUTH has not been charging since 2013 until we had policy somersault by Centers for Disease Control and Prevention ( CDC), the major funder for HIV programme in Nigeria. Funding of the programme remains intact. What changed in 2013, number one is the cost of assessing the safety of antiviral therapy that changed and since 2013 in LUTH, HIV infected patients have been paying for that, what also changed in 2013 is the payment of consultation fees by the programme on behalf of the patients. Other hospitals have been charging, but LUTH did not charge it until January 2024," he said.
Akanmu also clarified further that over 22,000 patients enrolled for HIV treatment at LUTH but only about 6,800 remain actively in care currently.