Addressing Economic Barriers to Treatment
During a presentation at NIMR’s monthly research chat in Yaba, Lagos, Dr. Kazeem Osuolale, a biostatistician and Senior Research Fellow at the institute, explained the motivation behind the study. While antiretroviral drugs have transformed HIV from a fatal disease to a manageable chronic condition, many patients still face challenges in consistently taking their medication.
“Even though the drugs themselves are free, the financial burden of accessing them regularly—transportation, clinic fees, and other costs—can be overwhelming,” Dr. Osuolale noted. Poverty remains a significant barrier in Nigeria’s efforts to curb HIV/AIDS, prompting researchers to explore new ways to address this issue.
The Study Design: Testing an Empowerment Model
To evaluate a possible solution, the research team launched a pilot randomized controlled trial titled Empowerment Models for Improving Human Immunodeficiency Virus (HIV) Patients’ Adherence to Antiretroviral Drugs. Conducted between July 2021 and February 2023, the trial involved 50 HIV-positive patients aged 15 to 45 who had been on ART for at least three months but were struggling with adherence rates below 95 percent.
Participants were split into two groups. The experimental group received vocational skills training and start-up materials to enable small-scale businesses in catering, bead making, liquid soap production, and hair braiding. The control group received standard care without the empowerment component.
“The aim was not just to give them a skill but to build confidence, independence, and a means of supporting themselves financially,” Osuolale explained.
Measurable Improvements in Treatment Adherence
Results from the study demonstrated a clear difference between the two groups. Participants in the experimental group increased their ART adherence from an average of 68.76 percent at baseline to 109.72 percent post-intervention. Meanwhile, the control group also improved—but less dramatically—from 83.66 percent to 99.44 percent. Statistical testing confirmed this difference was significant, with a p-value of 0.044.
Dr. Osuolale emphasized that economic empowerment appeared to reduce financial stress and eliminate barriers to regular treatment access. “When patients are financially empowered, they are more likely to keep clinic appointments and pick up their medication on schedule,” he said.
Income and Demographic Observations
The study also highlighted the economic vulnerability of participants. Among the experimental group, 16 out of 25 participants reported monthly incomes between N0 and N15,000, compared with 8 in the control group. Other demographic factors such as age, marital status, education, and employment type showed no major differences between groups, underscoring that the economic intervention itself was the primary factor behind improved adherence.
Limitations and Recommendations
While the findings are promising, Dr. Osuolale acknowledged the limitations of the pilot study. The sample size was relatively small, and the follow-up period lasted only three months. He recommended that future research should use larger samples and longer follow-up periods to better understand the long-term effects of vocational training on ART adherence.
A Call for Policy Integration
The study concludes with an appeal to health policymakers and program funders to consider incorporating empowerment strategies into routine HIV care. “It is time we invest not only in medication but in the lives of patients,” Dr. Osuolale urged. “Skills give them purpose, independence, and the financial capacity to stay on treatment.”
By linking healthcare outcomes to economic empowerment, the study offers a practical approach to supporting Nigeria’s fight against HIV/AIDS, suggesting that holistic care strategies can deliver both health and economic benefits.