Access to antiretroviral drugs in rural communities in nigeria

Background: The birth of a number of global health initiatives designed to increase access to HIV antiretroviral therapy (ART) in low and middle income countries has greatly increased the availability of these drugs in low and middle income countries over the last decade. Vertical programs such as the President's Emergency Program for AIDS Relief have greatly increased availability, but still have not reached their goals. Barriers in every aspect, including barriers healthcare providers face in receiving ART and the actual process they undergo to access ART, need to be assessed in order to understand what prevents treatment access goals from being achieved. Furthermore, criticisms of "vertical" programs targeted at a single disease have raised concerns about their possible deleterious effects on the overall strength of health systems in low and middle-income countries.;Methods: We conducted in-depth interviews with staff members and clinicians in clinics and hospitals in rural and urban areas in Ekiti State, Nigeria to assess their current stocks of ART and HIV services and barriers to providing HIV care and treatment.;Result: Four themes emerged from the interviews: 1. Rural hospitals and clinics had to seek out access to ART through a highly centralized process; 2. Bureaucracy, in which the hospitals have to go through excessive, complicated, administrative procedures and deal with power-ridden representatives and stakeholders in the supply chain, was a major supply chain barrier and this factor is displayed more in health facilities in rural areas than urban areas; 3. The most common individual barrier HIV patients face in accessing and using ART is stigmatization, followed by poverty; 4. Most of the clinicians and health workers in the study suggested that the ART distribution process be decentralized from regional levels to state levels to facilitate distribution of ART.;Conclusion: There is adequate access and distribution of ART in secondary and nearly all tertiary health centers in Ekiti State, whilst primary health centers, which are mostly in rural areas, only provide testing and counseling services, and lack ART supplies and staff training. Politics and bureaucracy plays into determining which health centers receive trained to be able to distribute ART. In order to decrease the weakness and bottlenecks of the ART supply chain in Nigeria, the distribution process could be decentralized from the regional levels to lower levels.