Home Delivery of Antiretrovirals as an Option for Mitigating Challenges in Accessing HIV Medication in Anambra State, Nigeria

Home delivery has the potential to enhance access to antiretroviral therapy (ART). This study aimed to compare the impact of an ARV home delivery model on patients’ viral load outcomes against facility refills. Three hundred sixteen (316) HIV-diagnosed patients were recruited for the study, with 158 from each of two randomly selected hospitals in Anambra that met the qualifying criteria. Participants were randomly assigned to the intervention or control group using the web-based random number generator, each participant’s received ARV medications at home every three months and viral load tests every six months over two years. Their outcomes were compared to a control group receiving facility-based care. Statistical analyses included the Chi-square test, Fisher’s exact test, and independent t-test, with a two-sided p-value of <0.05 signifying significance. All participants were included in the analysis (intention to treat). Patients’ willingness to pay for this service was assessed using a contingent valuation approach with the payment card technique. On recruitment, most clients were females. Also, majority of the clients had a basal viral load range of 21-10,000 cp/mL, with 74.7% at the intervention group and 81.7% at the control group. By 6th and 12th month, 69.0% and 70.9% of the intervention group achieved a viral load of <20 cp/mL, compared to 69.6% and 71.2% at the control group. These differences were not statistically significant (p-values of 0.07 and 0.09). At 18th and 24th months, 84.0% and 78.0% of the intervention group achieved viral load suppression of <20 cp/mL, while the control group had rates of 89.1% and 79.1%. These results were statistically significant, with p-values of 0.04 and < 0.001, respectively. On trial exit, majority of clients (89.7% in the control group and 85.9% in the intervention group, p < 0.001) expressed a willingness to pay for the home delivery service. Home delivery of ARVs positively impacts viral load outcomes, and patients are willing to pay this service.