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Title
Achieving sustainability of Unitaid investment in HIV self-testing through demand-side subsidy financing: successes and lessons learnt from STAR-Nigeria partnerships with private pharmacies
Presenter
Victor Abiola Adepoju
Authors
V.A. Adepoju1, A. Solanki2, C. Umebido1, Z. Hassan1, A. Ajijelek1, W. Oladigbolu3, I.-J. Dada4, C. Nwakaego4, Y. Olaifa5, G. Ujam5, D. Ndukwe5, A. Oniyire6, C. Laube7, M. Strachan8, K. Grabbe7
Institutions
1Jhpiego Nigeria, an affiliate of John Hopkins University, HIV and Infectious Diseases, Abuja, Nigeria, 2Population Services International, HIV and TB International, Cape Town, South Africa, 3Association of Community Pharmacist of Nigeria, Abuja, Nigeria, 4National AIDS/STI Control Program, Abuja, Nigeria, 5National AIDS Control Agency, Abuja, Nigeria, 6Jhpiego Nigeria, an affiliate of John Hopkins University, Abuja, Nigeria, 7Jhpiego USA, HIV and Infectious Diseases, Baltimore, United States, 8Jhpiego USA, Baltimore, United States

BACKGROUND: The Unitaid HIV self-testing in Africa (STAR) project, implemented by Jhpiego in Nigeria in collaboration with the Ministry of Health and key stakeholders distributed 318,750 oral and blood-based HIV Self-testing (HIVST) kits through 5 distribution models between 2020-2022. A demand side financing pilot, addressing barriers of high commodity cost and poor demand, to increase access and uptake of HIVST through private sector pharmacies as a sustainable model of HIVST was implemented between November 2021 and October 2022. We aimed to demonstrate that implementation of demand side subsidy financing would lead to sustainable HIVST market through private pharmacies in Nigeria.
DESCRIPTION: Demand side financing (DSF) was implemented between November 2021-October 2022 as a strategy to scale and sustain HIVST through the private sector in Nigeria. We mapped 166 private retail pharmacies across four Nigerian states, trained pharmacists on HIVST detailing, and provided simplified digital reporting tools and promotional materials. We used the “buy 1 get 3 free “model to stimulate demand and gradually transferred costs to end users through 3 cost transfer phases at agreed end-user profit margins. Consumers (walk-in, online referrals, referrals by community-based organizations) redeemed paper- or digital vouchers to receive HIVST kits. The cascade of voucher redemption, demand for HIVST and investment made by private pharmacies were tracked.
LESSONS LEARNED: A total of 2,920 HIVST kits (USD$10,000 value) were purchased by 166 pharmacies within 3 months of first and second cost transfers. Voucher redemption dropped initially from 91% in the free phase to 60% in the first and then increased to 72% in the second cost transfer phases . 85% of pharmacies invested at least USD$10-50. Of the 12,718 kits distributed across the three phases, community referrals, walk-in and online referrals accounted for 75%, 21.3% and 3.4% of HIVST uptake respectively. Additional investment of USD$32,000 have been made by pharmacies in scale-up states, via pooled procurement by the Association of Community Pharmacists of Nigeria, after DSF pilot.

CONCLUSIONS: The DSF initiative was effective in sustaining market for fee-based HIVST in Nigeria. The successful pilot has been expanded country-wide through the governance structure of the “Local Pharmacy Distribution Network”.

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