Engaging Nigeria's Private Health Sector for a Stronger HIV Response

However, private provision of HIV services is low, especially for care and treatment. In Lagos, approximately two-thirds of private providers offer HIV counseling and testing services, but only 10 percent offer full adult antiretroviral therapy (ART). The United States Agency for International Development (USAID), through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), aims to strengthen Nigeria's HIV response by increasing access to comprehensive HIV services through the private sector. Nigeria has the second-largest population of people living with HIV (PLHIV) in the world, with an estimated 3.2 million individuals. In 2017, only 967,000 were on ART, and to reach global 90-90-90 goals, an additional 1.6 million PLHIV will need to start ART by 2020. In Lagos and Rivers states, where over 350,000 PLHIV are not on ART, the private sector is a largely untapped partner that can make significant contributions. The private sector could address a large share of the unmet ART need. To capitalize on this opportunity, the USAID-funded Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project conducted a market analysis of supply and demand for HIV services in Lagos and Rivers states. The market analysis aimed to inform a market strategy for engaging and serving 20,000 to 30,000 PLHIV in these two states through the private sector. The assessment addressed four questions: what factors in Lagos and Rivers states influence healthcare access in the public and private sectors; who are PLHIV, what is their health-seeking behavior, and how much do they spend on healthcare; what is the current and potential role for private providers; and what existing models and conditions enable successful private HIV service delivery. The SHOPS Plus data collection efforts revealed how PLHIV move through the health system in Nigeria and where they may have opportunities to interact with the private sector for their HIV-related needs. The journey through the typical client pathway reveals several common considerations that shape PLHIV decision making, including stigma, confidentiality, dignity, and staff expertise. The private sector's role in HIV service delivery is further hampered by the apparent lack of private-private and public-private referral networks. Without these networks, clients who test positive for HIV in private facilities that do not offer ART are generally referred directly to the public sector for treatment, even if they would prefer to receive their care in the private sector. The SHOPS Plus assessment identified three factors that interact to shape how PLHIV in Rivers and Lagos seek HIV services: the length of time that someone has been living with their diagnosis, the facility (public or private) where they usually go for healthcare, and their income level. As a result, seven distinct market segments of PLHIV were identified, each with unique characteristics and needs.