Willingness to pay (WTP) for HIV and AIDS services in Africa: A systematic review

Abstract

Background: While Africa is the continent most affected by HIV and AIDS, its response to HIV and AIDS remains largely donor supported. However, in the face of declining donor support, alternative ways to sustainably support HIV and AIDS responses in Africa are paramount. This systematic review explores the willingness to pay (WTP) for HIV services in Africa as a potentially more sustainable HIV and AIDS service cost recovery approach. Methods: A comprehensive systematic search for literature was conducted in electronic databases and websites of HIV and AIDS organisations for studies that reported on the willingness to pay for HIV services in Africa. Preference studies that did not use the WTP approach and that were conducted outside Africa were excluded. Information on the HIV service, the methods used in the studies and factors that influence WTP were extracted. A descriptive thematic analysis was undertaken. The findings are summarised in tables and graphs. Results: A total of 5,139 records were returned and screened for eligibility from the initial search. After screening and removal of duplicates, twenty-two articles from 10 countries with 19,611 study participants were included in the final review. There is an uneven distribution of WTP studies across different types of HIV services and across countries. There is evidence of a willingness to pay for HIV services, with the proportion of people reported in individual studies that are willing to pay, ranging from 34.3% to 97.1%. However, inthe majority of studies (71.4%, 15/21), the amount people are willing to pay cannot cover the cost of the full service in an open market. Factors associated with WTP include socioeconomic status, beliefs, and knowledge about HIV services. Conclusion: The current systematic review presents evidence of cost recovery from HIV programs. The main finding is that other resources, beyond out-of-pocket payments, are needed to meet the full cost of any service. This has implications for the provision of (nondonor-funded) services on a sustainable level in the long term. Systematic review registration: PROSPERO, registration number CRD42021275215