Medi e anean Jou nal o
Pha macy & Pha maceu ical Sciences ISSN: 2789-1895 online
www.medjpps.com ISSN: 2958-3101 p in
Giwa HB e al. (2025) Medi e J Pha m Pha m Sci. 5(4): 11-20. 11
ORIGINAL RESEARCH a icle
Budge impac analysis o al e na i e s a egies o ini ia ing an i e o i al
he apy in Nige ia
Halima B. Giwa 1 * , Muslim O. Jamiu 1 , Oye onke M. Aiyele o 2 , Abdul aheem Abdul 1
Abdulganiyu Giwa 1 , Oluwasegun I. Eniayewu 3 , and Fa ihu A. S. Giwa 4
1 Depa men o Clinical Pha macy and Pha macy P ac ice, Facul y o Pha maceu ical Sciences, Uni e si y o Ilo in,
2 Depa men o Pha macology and Toxicology, Facul y o Pha maceu ical Sciences, Uni e si y o Ilo in,
3 Depa men o Pha maceu ical and Medicinal Chemis y, Facul y o Pha maceu ical Sciences, Uni e si y o Ilo in,
Ilo in, Kwa a S a e, Nige ia, and 4 Facul y o Pha macy, Teh an Uni e si y o Medical Sciences, Teh an, I an
* Au ho o whom co espondence should be add essed
A icle numbe : 226, Recei ed: 03-08-2025, Accep ed: 07-10-2025, Published online: 09-10-2025
HOW TO CITE THIS
Giwa HB, e al. Budge impac analysis o al e na i e s a egies o ini ia ing an i e o i al he apy in Nige ia.
Medi e J Pha m Pha m Sci. 2025; 5(4): 11-20. [A icle numbe : 226]. h ps://doi.o g/10.5281/zenodo.17307273
Keywo ds: Financial impac e alua ion, highly ac i e an i e o i al he apy, HIV in ec ion
Abs ac : The Wo ld Heal h O ganiza ion (WHO) has ecen ly made ecommenda ions o ea ing all Human
Immunode icency Vi us (HIV/AIDS) pa ien s i espec i e o hei immune s a us. This issue poses challenges o
lowe -middle-income coun ies like Nige ia due o esou ce limi a ions. This s udy pe o med a budge impac
analysis (BIA) o di e en s a egies o he ini ia ion o an i e o i al he apy (ART) among indi iduals li ing
wi h HIV/AIDS in Nige ia. A dynamic coho budge impac model was used o compa e wo ini ia ion a ms
(CD4 < 350 cells/ml and CD4 > 500 cells/ml), wi h CD4 > 500 cells/ml ep esen ing he 2015 WHO guidelines
o ini ia ion o ART. Ou comes we e hospi aliza ion cos s, new in ec ion ansmission, and o e all budge
impac . Key inpu s included HIV p e alence in Nige ia, ART access and cos s, hospi aliza ion a es and cos s,
ART up ake ends, and ansmission a es. Sensi i i y analysis empolyed Mon e Ca lo simula ions o assess he
impac o selec ed pa ame e s. A he end o yea i e, applying he 2015 WHO guidelines educed new HIV
ansmissions by 87.0%, p e en ing 77,000 in ec ions. Hospi aliza ion cos educ ions sa ed $1.12 million.
O e all budge impac s we e $718 million o immedia e ini ia ion e sus $903 million o de e ed ini ia ion,
yielding $184 million in sa ings. Mon e Ca lo simula ions showed educed ansmission as he main d i e o
sa ings. P io i izing ea ly ea men ini ia ion espoused by he 2015 WHO guidelines maximize esou ce
e iciency, educes long- e m heal hca e cos s, and accele a e p og ess owa d epidemic con ol a ge s. The
indings s ongly suppo he adop ion and sus ained implemen a ion o he 2015 WHO guidelines o immedia e
ART ini ia ion. I has public heal h and economic bene i s.
In oduc ion
Human immunode iciency i us/Acqui ed immune de iciency synd ome (HIV/AIDS) emains a majo cause o
mo bidi y and mo ali y in many pa s o he wo ld, pa icula ly in low- and middle-income coun ies (LMICs)
[1]. AIDS, which esul s om un ea ed in ec ion wi h HIV-1 o HIV-2, is cha ac e ized by a p o ound de ec in
Copy igh © 2025. This open-access a icle is dis ibu ed unde he C ea i e Commons A ibu ion License, which pe mi s
un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed.
Medi e anean Jou nal o
Pha macy & Pha maceu ical Sciences ISSN: 2789-1895 online
www.medjpps.com ISSN: 2958-3101 p in
Giwa HB e al. (2025) Medi e J Pha m Pha m Sci. 5(4): 11-20. 12
cell-media ed immuni y and ep esen s he ad anced s age o HIV in ec ion [2]. Nige ia bea s he second-la ges
HIV epidemic globally, wi h a p e alence a e o 1.4% as o 2020, indica ing ha abou 1.9 million indi iduals
we e li ing wi h HIV [3]. This epidemic poses a signi ican global heal h challenge, as i o e s e ches heal hca e
se ices, educes li e expec ancy, lowe s child su i al a es, and inc eases he numbe o o phans. I le
un ea ed, HIV/AIDS can p og ess o ad anced s ages, leading o he de elopmen o oppo unis ic in ec ions and
malignancies [4]. An i e o i al he apy (ART) emains he co ne s one o HIV/AIDS managemen . Howe e ,
he ini ia ion guidelines om he Wo ld Heal h O ganiza ion (WHO) ha e e ol ed o e ime. Ini ially, ini ia ion
was ese ed o pa ien s wi h he lowes CD4 cell coun s who aced he highes isks o mo ali y and mo bidi y.
This app oach equi ed minimal esou ce alloca ion due o he limi ed numbe o pa ien s ini ia ed [1]. Ye ,
clinical ials conduc ed in he pas decade ha e demons a ed he clinical ad an ages o ea ly ini ia ion o ART
o all pa ien s, p omp ing he WHO o upda e i s ecommenda ions [5]. Consequen ly, he e e ence CD4 le els
o ini ia ing HIV ea men shi ed o e ime, om a h eshold o < 200 cells/ml in 2003 o a ange o 200-500
cells/ml in 2013, and by 2015, ea men was ecommended o all pa ien s ega dless o CD4 coun , including
hose wi h coun s abo e 500 cells/ml [5]. Despi e hese p og essi e changes in ea men guidelines, a pe sis en
dispa i y emains be ween he a ailable unding and he inancial esou ces equi ed o mee global HIV/AIDS
a ge s [6-8]. This dispa i y can be shown in he ac ha o al HIV/AIDS expendi u e in Lowe Middle-Income
Coun ies (LMICs) ose om $4.0 billion o $19 billion be ween 2000 and 2016. Howe e , much o his inc ease
in unding has been concen a ed in jus en LMICs, including Nige ia, he eby e lec ing a signi ican imbalance
in esou ce dis ibu ion [6]. The Nige ian Go e nmen has adop ed and implemen ed he 2015 guidelines o he
ini ia ion o ART a he acili y le el [4]. The e o e, i is c ucial o examine he a o dabili y o his ini ia ion
s a egy o he Na ional heal h sys ems. This is pa icula ly pe inen due o se e al ac o s: he coun y's
ela i ely low heal h expendi u e pe capi a, which is cha ac e is ic o low-income coun ies [9]; a dec ease in
o eign aid p e iously p o ided by high-income coun ies [10]; and a ela i ely high HIV p e alence a e o 1.4%,
d i en by Nige ia's la ge o al popula ion o o e 200 million people [11]. A Budge Impac Analysis e alua es
he an icipa ed changes in heal hca e sys em expendi u es ollowing he implemen a ion o a new in e en ion.
Used o budge o esou ce planning, i can be ees anding o pa o a comp ehensi e economic assessmen
along wi h a cos e ec i eness analysis (CEA) [12]. I p o ides da a on he a o dabili y o new heal h-ca e
echnologies a a gi en p ice o a speci ied popula ion p io o eimbu semen [13]. CEA compa es cos s and
ou comes o compe ing in e en ions; i ends o po end which in e en ion gi es mo e alue o money [14-16].
Pas li e a u e has e ealed ha he ini ia ion o ART using he 2015 guidelines (which ecommend s a ing
ea men ega dless o CD4 coun ) has been ound o be cos -e ec i e, o e ing g ea e clinical and economic
bene i s compa ed o p e ious guidelines [1, 5, 17], he eby p o iding alue o money. Simila ly, a budge impac
analysis conduc ed in Cô e d’I oi e epo ed ha immedia e ART ini ia ion inc eased he 5-yea HIV ca e budge
om $801.9 million o $812.6 million, compa ed o ini ia ion a CD4 < 350 cells/µL1. This s udy aims o e alua e
he budge a y impac o al e na i e s a egies o ini ia ing ART in pa ien s wi h HIV/AIDS in Nige ia, h ough
an assessmen o , he incidence o new HIV in ec ions, he numbe o unscheduled hospi aliza ions, associa ed
hospi aliza ion cos s, and o e all budge impac .
Ma e ials and me hods
Se ing and loca ion: Nige ia, o icially known as he Fede al Republic o Nige ia, is loca ed in he sou heas e n
egion o Wes A ica, wi h a coas line along he Bigh o Benin and he Gul o Guinea. I sha es land bo de s
wi h Benin, Came oon, Chad, and Nige , and ma i ime bo de s wi h Equa o ial Guinea, Ghana, and São Tomé
Medi e anean Jou nal o
Pha macy & Pha maceu ical Sciences ISSN: 2789-1895 online
www.medjpps.com ISSN: 2958-3101 p in
Giwa HB e al. (2025) Medi e J Pha m Pha m Sci. 5(4): 11-20. 13
and P íncipe. Co e ing an a ea o 923,768 km², i is nea ly ou imes he size o he Uni ed Kingdom and sligh ly
mo e han wice he size o he U.S. s a e o Cali o nia [18]. The capi al ci y is Abuja, si ua ed in he cen al pa
o he coun y [19]. Nige ia has a GDP pe capi a o $2,222.01[20], a li e expec ancy a bi h o 55 yea s, and a
pe capi a heal h expendi u e o $21715.
Inpu pa ame e s
Ta ge popula ion and subg oups: The o al popula ion ollowed o his s udy was de e mined by conside ing
he epidemiology o he disease and accessibili y o an i e o i als. Based on a na ional HIV p e alence a e o
1.4% in 2020 and an es ima ed popula ion o 206 million, app oxima ely 1.9 million people we e li ing wi h HIV
in Nige ia [21], as con i med by p e iously published sou ces [22, 23] (Table 1). Al hough Nige ia adop ed he
2015 ART guidelines, only 55.0% o people li ing wi h HIV had access o ART as o he la es epo s [19, 22].
As a esul , he o al popula ion ha is al eady on ART as a 2019 is 1,045,000. I is wo h men ioning he e ha
a Nige ia's na ional heal h sys ems le el, ce ain ac o s ha e in luenced access o an i e o i al, including poo
inancing and logis ics, poo poli ical will and co up ion, une en sp ead and each o go e nmen heal h acili ies,
low employmen o heal h wo ke s, and low wages [19].
Table 1: Inpu pa ame e : Ta ge popula ion and subg oups
P e alence
1.4%, [19, 22]
Numbe li ing wi h HIV
1.9 million, [19, 22]
Access o ART adul
55.0%, [19]
Annual cos pe pe son o ART
$ 397, [24]
Cos o Hospi aliza ions
$ 51, [24]
Compa a o s /assump ions o budge impac analysis: The wo compe ing s a egies ha a e being compa ed
a e: P e ious me hods o ini ia ion / de e ed he apy ini ia ion. This is de ined as ini ia ion in pa ien s wi h a CD4
cell coun o < 350 cells/ml, and he 2015 guidelines o ini ia ion o an i e o i al he apy/immedia e he apy
ini ia ion, which is de ined as ini ia ion in pa ien s wi h a CD 4 cell coun > 500 cells/ml. The de e ed he apy
ini ia ion me hods we e compa ed wi h he immedia e he apy a m o ini ia ion. The de e ed he apy se ed as
he e e ence me hod. The model had annual cycles wi h a 5-yea ime ho izon. A he end o each cycle, he
annual budge impac was compu ed. This was done in ela ion o he an icipa ed change in sexual ansmission
o HIV (hence he numbe o new cases o HIV) and he numbe o unscheduled hospi aliza ions. The numbe o
new HIV cases was added a he beginning o each new cycle. P ecisely, he base case alues a e assumed o be
in ope a ion in 2019, which is comple ely subs i u ed by he immedia e he apy ini ia ion by 2020. In subsequen
yea s a e 2020, i is assumed ha up ake o an i e o i al will inc ease a 10.0% pe yea (Table 2). This
assump ion was made since his me hod o ini ia ion en ails ha 100% o pa ien s should be adminis e ed
an i e o i al he apy. Acco ding o s udies, 100% access o an i e o i al has no been achie able in mos
coun ies ha ha e adop ed he guideline [25], o ins ance, 70.0% o Lowe Middle-Income Coun ies (LMIC)
had his guideline adop ed, and 69.0% we e in ol ed in i s implemen a ion, and global access o ART has been
epo ed as 79.0% as opposed o 100%.
Time ho izon: The ime ho izon o his analysis was i e yea s, and his ime was chosen because policy make s
usually occupy hei o ices o abou ou yea s in Nige ia. This ime ho izon will enable hem o de e mine he
a o dabili y o he new guidelines while s ill in o ice. Incidence o HIV and cos may also change and a ec
esul s o he analysis i a longe ime ho izon is chosen.
Medi e anean Jou nal o
Pha macy & Pha maceu ical Sciences ISSN: 2789-1895 online
www.medjpps.com ISSN: 2958-3101 p in
Giwa HB e al. (2025) Medi e J Pha m Pha m Sci. 5(4): 11-20. 14
Discoun : Discoun ing was no employed in his analysis since, in acco dance wi h expe opinion and s anda d
me hodology, i should be a oided in BIA.
S udy pe spec i e: Pe spec i e o he s udy was ha o he Nige ian Na ional Heal h Sys ems, since unding o
he HIV p og ammed was by he go e nmen s o Nige ia in conjunc ion wi h in e na ional dono s.
Heal h ou comes: The main heal h ou come we e changes numbe o unscheduled hospi aliza ions, associa ed
hospi aliza ion cos s, he incidence o new HIV in ec ions, and o e all budge impac . Condi ions associa ed wi h
he wo ini ia ion s a egies had ea lie been in es iga ed in a andomized con ol ial known as he s a egic
iming o an i e o i al he apy ial (START). This ial was designed o assess he clinical isks and bene i s o
ini ia ing ART immedia ely in asymp oma ic HIV-posi i e pa ien s wi h a CD4+ coun g ea e han 500 cells/µL,
compa ed o de e ing ea men un il he CD4+ coun alls below 350 cells/µL. The esul s o his ial showed
ha ini ia ion in pa ien s wi h CD4 coun o > 500 cells/ml was associa ed wi h less nega i e clinical e en s when
compa ed wi h ini ia ion in pa ien s wi h CD4 coun o <350 cells/ml, in addi ion o he abo e he e was a
signi ican educ ion in he a es o unscheduled hospi aliza ion in pa ien s wi h CD4 coun o > 500 cell/ml [5].
O he s udies has also sugges ed ha immedia e he apy me hod o ini ia ion o an i e o i al educes in ec i i y
[26-29]. I is on his p emise ha he model in his s udy was made o include changes in a es o unscheduled
hospi aliza ions and changes in in ec i i y. This was la e ansla ed o changes in he cos o hese wo a iables
as indica ed on Table 2.
Table 2: Inpu pa ame e : Assump ions o budge impac analysis Nige ia
Va iable
Immedia e
ini ia ion
De e ed
ini ia ion
Ra es o Unscheduled Hospi aliza ions
3.94%, [1]
4.3%, [1]
Ra es o T ansmission o new in ec ions
0.85%, [26]
5.6%, [26]
Annual inc ease in cos pe pa ien o An i e o i al
10.0% o one yea (Expe opinion)
Annual inc ease in access o An i e o i al he apy
10.0% o one yea (Expe opinion)
Es ima ing esou ces and cos s: The sou ce o da a on a e age cos pe pe son on ART was a s udy conduc ed by
he wo ld bank. The s udy had he aim o unde s anding he cos s and de eloping a p ac ical, sus ainable inancing
plan as a co e equi emen o each coun y o success ully achie e HIV and Uni e sal Heal h Co e age (UHC)
goals. The analysis e alua ed he cu en cos s and inancial equi emen s o UHC and HIV, p ojec ing u u e
needs h ough o he 2030 a ge . This assessmen ocused on ou coun ies: Cô e d’I oi e, Kenya, Tanzania, and
Nige ia. The indings e ealed ha hese p og ams cu en ly cos app oxima ely US $481 pe pe son li ing wi h
HIV (PLWH), la gely sus ained h ough signi ican dono suppo . Speci ically o Nige ia, he cos pe pe son
on ART was es ima ed a US$329, wi h a ange o US$301 o US$376.
Annual cos o hospi aliza ions we e de i ed om publica ions o local heal h expendi u es adjus ed o he alue
o 2019 dolla s ( 20A) as shown on Table 2. The model o choice is shown in Figu e 1.
Fu he assump ions: The s udy adhe es o he BIA guidelines ega ding p inciples o good p ac ice om he
In e na ional Socie y o Pha macoeconomics and Ou come Resea ch (ISPOR) [12]. The BIA was pe o med
using a dynamic model, a model ha allowed he en ance o new pa ien s e e y yea . The new en an s we e
de e mined om haza d a es de i ed om me a-analysis on he isk o sexual ansmission o HIV [26].
Dynamism o he model would also indica e an assumed inc ease in annual cos pe pa ien o an i e o i al by
10.0% and an assumed 10.0% yea ly inc ease in up ake o an i e o i al.
Medi e anean Jou nal o
Pha macy & Pha maceu ical Sciences ISSN: 2789-1895 online
www.medjpps.com ISSN: 2958-3101 p in
Giwa HB e al. (2025) Medi e J Pha m Pha m Sci. 5(4): 11-20. 15
Sensi i i y analysis: unce ain y was assessed using Mon e Ca lo simula ions, and model alida ion was
pe o med by compa ing he esul s wi h indings om p e ious s udies in he ield.
Figu e 1: Model o budge impac analysis
A* Numbe o unscheduled hospi aliza ions, o al cos o hospi aliza ions, ansmission o new in ec ions, he o e all budge impac s
B* Numbe o unscheduled hospi aliza ions, o al cos o hospi aliza ions, ansmission o new in ec ions, he o e all budge impac s
Resul s
Numbe o new ansmissions: A he end o yea 5, compa ing he immedia e he apy a m o he de e ed he apy
a m e ealed an 87.0% educ ion in new ansmissions. This esul ed in he p e en ion o abou 77,000 in ec ions,
as shown on Figu e 2.
Figu e 2: Numbe o new in ec ions
Numbe and cos o hospi aliza ions: O e i e yea s, compa ing de e ed he apy o immedia e he apy showed
a educ ion in bo h he numbe and cos o hospi aliza ions. This esul ed in a ne sa ings o $1,116,796.84 in
hospi aliza ion expenses by he end o yea 5, amoun ing o a 27.0% ne sa ings (Figu e 3).
(100,000.00)
(50,000.00)
-
50,000.00
100,000.00
2019 2020 2021 2022 2023
Numbe o pe sons
Yea unde e iew
Numbe o new ansmissions
New T ansmission (Immedia e)
New T ansmission (De e ed)
Eligible Popula ion
Time Ho izon T ea men Mix Cos and Ou come Resul
All HIV
posi i e
pa ien s in
Nige ia
5 yea s
De e ed ini ia ion
CD4<350
Immedia e ini ia ion
CD4>350
A*
B*
Budge impac o
Immedia e a m
o ini ia ion
Medi e anean Jou nal o
Pha macy & Pha maceu ical Sciences ISSN: 2789-1895 online
www.medjpps.com ISSN: 2958-3101 p in
Giwa HB e al. (2025) Medi e J Pha m Pha m Sci. 5(4): 11-20. 16
Figu e 3: Cos o hospi aliza ions
Budge impac analysis: While bo h ini ia ion a ms expe ienced an inc ease in budge impac s, he de e ed
he apy a m showed a highe ise. Consequen ly, by yea 5, he e was a ne sa ing o 20.0%. This equa ed o an
absolu e ne sa ing o $ 184,452,491.44 as illus a ed on Figu e 4.
Figu e 4: Budge Impac analysis o al e na i e a ms o ini ia ing an i e o i al he apy
Mon e Ca lo simula ion: T ansmission a e was he la ges con ibu o o sa ings, because Lowe ansmission
educes u u e pa ien load, and his amoun s o less ART, hospi aliza ion, and downs eam cos s. Hospi aliza ion
a e was he second la ges con ibu o o sa ings. Ea ly ea men educes hospi aliza ions, hen sa ings g ow
o e ime 10.0% ART p ice inc ease has he same a e applied o bo h, bu penalizes de e ed mo e because i
ea s mo e pa ien s a highe u u e p ices. Ac s as a mul iplie (Figu e 5).
Figu e 5: Mon e Ca lo simula ions showing he magni ude o in luence o inpu pa ame e s on budge
impac o immedia e e sus de e ed ART
(2,000,000.00)
-
2,000,000.00
4,000,000.00
6,000,000.00
2019 2020 2021 2022 2023
Cos in USD
Yea unde e iew
Cos o hospi aliza ions
To al cos s o
hospi aliza ions(
Immedia e)
To al cos s o
hospi aliza ions
(De e ed)
Change in
hospi aliza ion cos
(400,000,000.00)
(200,000,000.00)
-
200,000,000.00
400,000,000.00
600,000,000.00
800,000,000.00
1,000,000,000.00
1 2 3 4 5
Budge impac
Budge Impac
(Immedia e)
Budge impac
(De e ed)
Change in
budge impac
Ve y high
Medium-high
Mode a e, indi ec
0 1 2 3 4 5 6
T ansmission a e
Hospi aliza ion a e
10% ART p ice inc ease
Magni ude o sco e 1-5
Mon e ca lo simula ions showing magni ude o in luence o inpu pa ame e s on
Budge impac
Medi e anean Jou nal o
Pha macy & Pha maceu ical Sciences ISSN: 2789-1895 online
www.medjpps.com ISSN: 2958-3101 p in
Giwa HB e al. (2025) Medi e J Pha m Pha m Sci. 5(4): 11-20. 17
Discussion
The 87.0% educ ion in new HIV ansmissions o e i e yea s led o signi ican heal hca e cos sa ings. Also,
dec eased mo bidi y and mo ali y among pa ien s ini ia ed on ART unde he 2015 guidelines is expec ed o
esul in inc eased p oduc i i y o e he same pe iod and in o he u u e yea s. This aligns wi h he indings ha
expanding access o ART, along wi h es ing and p e en ion e o s, has esul ed in a 59.0% decline in new HIV
in ec ions since he peak in 1995 [30]. The epo emphasizes ha uni e sal ART access and achie ing i al
supp ession a e c i ical o s opping HIV ansmission. This is consis en wi h he indings o Eisinge e al. [31],
who emphasized ha ART leading o i al supp ession elimina es he isk o sexual HIV ansmission. They no ed
ha achie ing widesp ead i al supp ession has he po en ial o signi ican ly educe HIV incidence and mo e
close o elimina ion. Likewise, he s udy by Gazzino e al. [32], which explo ed he Unde ec able =
Un ansmu able concep , con i med ha e ec i e ART elimina es he isk o HIV ansmission. When
implemen ed a scale, his has a signi ican impac on educing ansmission a he popula ion le el. The dec eased
numbe and cos o hospi aliza ions obse ed which esul ing cos sa ings o $1,116,796.84, was as a esul o
dec eases in he a es o hospi aliza ions and incidence o new in ec ions obse ed when he new guidelines a e
u ilized. This is in simila i y o s udies ha linked ART ini ia ion o a h ee old educ ion in hospi aliza ion a es
a e ou yea s on ea men [33]. I is es ima ed ha s a ing ART ea lie could sa e o e US $300,000 pe 1,000
pe son-yea s in hospi aliza ion cos s du ing he i s ou yea s o he apy [34]. Also, i was ound ha ea men -
expe ienced people wi h HIV using B/F/TAF (Bic eg a i /Em ici abine/Teno o i ala enamide) expe ienced
20.0% lowe HIV- ela ed medical cos s compa ed o some o he egimens, la gely h ough educed
hospi aliza ions. Also, a eal-wo ld analysis om I aly showed ha adhe ence o TAF-based ART signi ican ly
educed heal hca e esou ce use and hospi al- ela ed cos s, compa ed o less pe sis en egimens [35].
The o al cos equi emen s o ea men o he disease, which we e 718 and 903 million o he immedia e and
delayed a m o he apy espec i ely, we e simila o ha ga e es ima es o spending o high-bu den low-income
coun ies (HBLI) like Nige ia [36]. I was men ioned ha HBLI coun ies will end o spend mo e han low bu den
middle income coun ies o he managemen o HIV/AIDS. Coun ies in he HBLI ca ego y we e ad ised o
in ensi y p e en i e s a egies such as p e en ion o mo he - o-child ansmission, male ci cumcision, and
packages o communi y mobiliza ion, such as es ing, counseling, and condom p omo ion o sex wo ke s, hei
clien s, and men who ha e sex wi h men. Adop ion o low-cos managemen app oaches like ob aining u he
educ ions in he p ices o an i e o i al. Policymake s will be able o use his in o ma ion o measu e he
a o dabili y o he 2015 guidelines o ini ia ion o ART o decision making, and will p o ide in o ma ion
ega ding he inancial consequences o he 2015 guidelines. The absolu e ne sa ings o $184,452,491.44
obse ed when compa ing he 2015 guidelines o olde me hods o ini ia ion o ART gi es c edi o he new
guidelines, showing he e would be an inc ease in a o dabili y o heal h paye s. The e would be he ad an age
o he ne sa ings o se ing he ne cos o he disease in he nea u u e. This s udy ag ees wi h hose who also
ound ha he new guidelines will esul in cos sa ings in o u u e yea s [37]. The inc eases in cos componen s
obse ed we e due o an annual 10.0% inc ease in excess o ART. The indings showing dec eased incidence,
cos o unscheduled hospi aliza ions, and cos sa ings in e ms o annual budge impac s o he 2015 guidelines
o ini ia ion o ART will enhance he achie emen o UNAIDS o ending AIDS as a global public heal h h ea
by 2030. I is wo hy o no e ha hese a ge s canno be achie ed by implemen a ion o his guideline alone, a
he popula ion le el success can only be achie ed when he e is widesp ead es ing up ake, linkage wi h ca e,
up ake o he apy, e en ion o hese in he apy, adhe ence o medica ions and a a o able social con ex o he
occu ence o all hese [19, 38] and las ly educ ion o he ime be ween diagnosis and ini ia ion o he apy [39].
Medi e anean Jou nal o
Pha macy & Pha maceu ical Sciences ISSN: 2789-1895 online
www.medjpps.com ISSN: 2958-3101 p in
Giwa HB e al. (2025) Medi e J Pha m Pha m Sci. 5(4): 11-20. 18
Conclusion: The ne sa ings o $184 million, educ ion in incidence, and educ ion in a es and cos o
unscheduled hospi aliza ions unde he immedia e he apy model no only demons a e a o dabili y bu also o e
long- e m inancial sus ainabili y o heal h sys ems. These esul s s ongly suppo he implemen a ion o he
2015 WHO ART ini ia ion guidelines as a s a egic in es men . Howe e , achie ing he global HIV a ge s will
equi e mo e han policy change; i demands comp ehensi e popula ion-le el e o s, including widesp ead
es ing, linkage o ca e, adhe ence suppo , and educed delays be ween diagnosis and ea men . Only h ough
such coo dina ed ac ions can coun ies ully ealize he bene i s o ART scale-up and mee he UNAIDS 2030
goals.
Re e ences
1. Oua a a EN, MacLean RL, Danel C, Bo e ED, Gabilla d D, Huang M, e al. Cos -e ec i eness and budge impac
o immedia e an i e o i al he apy ini ia ion o ea men o HIV in ec ion in Cô e d’I oi e: A model-based
analysis. PLoS One. 2019; 14(6): e0219068. doi: 10.1371/jou nal.pone.0219068
2. Thompson MA, Abe g JA, Cahn P, Mon ane JS, Rizza dini G, Telen i A, e al. An i e o i al ea men o adul
HIV in ec ion: 2010 ecommenda ions o he In e na ional AIDS Socie y-USA panel. JAMA. 2010; 304(3): 321-
333. doi: 10.1001/jama.2010.1004
3. Celesia BM, Ma ino A, Del Vecchio RF, B uno R, Pale mo F, Gussio M, e al. Is i sa e and cos sa ing o de e
he CD4+ cell coun moni o ing in s able pa ien s on ART wi h mo e han 350 o 500 cells/μl? Medi e anean
Jou nal o Hema ology and In ec ious Disease. 2019; 11(1): e2019063. doi: 10.4084/MJHID.2019.063
4. Chu C, Selwyn PA. Complica ions o HIV in ec ion: a sys ems-based app oach. Ame ican Family Physician. 2011;
83(4): 395-406. PMID: 21322523.
5. Kuznik A, Iliyasu G, Habib AG, Musa BM, Kambugu A, Lamo de M. Ini ia ion o an i e o i al he apy based on
he 2015 WHO guidelines. AIDS. 2016; 30(18): 2865-2873. doi: 10.1097/QAD.0000000000001251
6. Haakens ad A, Moses MW, Tao T, Tsakalos G, Zla og B, Ka es J, e al. Po en ial o addi ional go e nmen
spending on HIV/AIDS in 137 low-income and middle-income coun ies: an economic modelling s udy. The Lance
HIV. 2019; 6(6): e382-e395. doi: 10.1016/S2352-3018(19)30065-8
7. Uddin MM, Rahman MM, Ra i IK, Khandake MS. Heal h p oblems in Bangladesh: A s uggle o equi able and
accessible heal hca e. Medi e anean Jou nal o Medicine and Medical Sciences. 2025; 1(1): 1-7. doi:
10.5281/zenodo.15606021
8. Elkami RM. Na iga ing pha macoeconomics in Libya: Ou cu en landscape. Medi e anean Jou nal o Pha macy
and Pha maceu ical Sciences. 2024; 4(3): 39-40. doi: 10.5281/zenodo.13622609
9. Global Bu den o Disease Heal h Financing Collabo a o Ne wo k. Pas , p esen , and u u e o global heal h
inancing: a e iew o de elopmen assis ance, go e nmen , ou -o -pocke , and o he p i a e spending on heal h o
195 coun ies, 1995-2050. The Lance . 2019; 393(10187): 2233-2260. doi: 10.1016/S0140-6736(19)30841-4
10. Fidle S, Fox J. P ima y HIV in ec ion: A medical and public heal h eme gency equi ing apid specialis
managemen . Clinical Medicine (Lond). 2016; 16(2): 180-183. doi: 10.7861/clinmedicine.16-2-180
11. Eluwa GIE, Adebajo SB, Eluwa T, Ogbanu e O, Ilesanmi O, Nzelu C. Rising HIV p e alence among men who
ha e sex wi h men in Nige ia: A end analysis. BMC Public Heal h. 2019; 19(1): 1201. doi: 10.1186/s12889-019-
7537-4
12. Sulli an SD, Mauskop JA, Augus o ski F, Ca o JJ, Lee KM, Minchin M, e al. Budge impac analysis-p inciples
o good p ac ice: epo o he ISPOR 2012 Budge Impac Analysis Good P ac ice II Task Fo ce. Value Heal h.
2014; 17(1): 5-14. doi: 10.1016/j.j al.2013.08.2291
13. Kalo Z, Landa K, Dolezal T, Voko Z. T ans e abili y o Na ional Ins i u e o Heal h and Clinical Excellence
ecommenda ions o pha maceu ical he apies in oncology o Cen al-Eas e n Eu opean coun ies. Eu opean
Jou nal o Cance Ca e (Engl). 2012; 21(4): 442-449. doi: 10.1111/j.1365-2354.2011.01297.x
14. Mo i AT, No heim OF, Robbe s ad B. Budge impac analysis o using dihyd oa emisinin-pipe aquine o ea
uncomplica ed mala ia in child en in Tanzania. Pha macoeconomics. 2016; 34(3): 303-314. doi: 10.1007/s40273-
015-0349-3
15. Onah PO. Knowledge and a i udes owa ds s oke in semi-u ban communi ies in No h Cen al Nige ia.
Medi e anean Jou nal o Pha macy and Pha maceu ical Sciences. 2025; 5(2): 8-19. doi: 10.5281/zenodo.15118429
Medi e anean Jou nal o
Pha macy & Pha maceu ical Sciences ISSN: 2789-1895 online
www.medjpps.com ISSN: 2958-3101 p in
Giwa HB e al. (2025) Medi e J Pha m Pha m Sci. 5(4): 11-20. 19
16. Igboamalu C, Dap im SO. Knowledge, a i ude, and p ac ice o pa ien e e al among pa en and p op ie a y
medicine endo s in Obio-Akpo , Ri e s S a e, Nige ia. Medi e anean Jou nal o Pha macy and Pha maceu ical
Sciences.. 2024; 4(2): 37-46. doi: 10.5281/zenodo.11391834
17. Zhao Y, McGoogan JM, Wu Z. The bene i s o immedia e ART. In e na ional Associa ion o P o ide s AIDS Ca e.
2019; 18: 2325958219831714. doi: 10.1177/2325958219831714
18. Uni ed Na ions. Wo ld popula ion p ospec s [In e ne ]. New Yo k: Uni ed Na ions; 2022 [ci ed 2025 Jul 30].
A ailable om: h ps://popula ion.un.o g/wpp/.
19. Awo ala AA, Ogundele OE. HIV epidemiology in Nige ia. Saudi Jou nal o Biological Sciences. 2018; 25(4): 697-
703. doi: 10.1016/j.sjbs.2016.03.006
20. Omenka CO. Fac o s in luencing access o an i e o i al ea men in Benue S a e, Nige ia [disse a ion]. Bell ille:
Uni e si y o he Wes e n Cape; 2010. A ailable om: h ps://e d.uwc.ac.za/handle/11394/2685.
21. UNAIDS. Nige ia: HIV and AIDS es ima es (2020) [In e ne ]. Gene a: UNAIDS; 2021 [ci ed 2025 Jul 30].
A ailable om: h ps://www.unaids.o g.
22. Oladele EA, Badejo OA, Obanubi C, Okechukwu EF, James E, Owhonda G, e al. B idging he HIV ea men gap
in Nige ia: examining communi y an i e o i al ea men models. Jou nal o In e na ional AIDS Socie y. 2018;
21(4): e25108. doi: 10.1002/jia2.25108
23. Na ional Agency o he Con ol o AIDS (NACA); Fede al Minis y o Heal h; Uni e si y o Ma yland, Bal imo e;
CDC; NAIIS Conso ium. NAIIS P elimina y Findings. Abuja (NG): NACA; Ma 2019. A ailable om: NACA
websi e.
24. Adoga A, Nimku T, Silas O. Ch onic suppu a i e o i is media: Socio-economic implica ions in a e ia y hospi al
in No he n Nige ia. Pan A ican Medical Jou nal. 2010; 4: 3. PMID: 21120075; PMCID: PMC2984277.
25. Sabin CA. Do people wi h HIV in ec ion ha e a no mal li e expec ancy in he e a o combina ion an i e o i al
he apy? BMC Medicine. 2013; 11(1): 251. doi: 10.1186/1741-7015-11-251
26. Da a i M, Giwa HB, Nabizade A, Tahe i F, Giwa A. An i e o i al he apy and he isk o sexual ansmission o
HIV: A sys ema ic e iew and me a-analysis. HIV Medicine. 2020; 21(9): 629-638. doi: 10.1111/hi .12901
27. Ini ia ion o an i e o i al he apy in ea ly asymp oma ic HIV in ec ion. The New England Jou nal o Medicine.
2015; 373(9): 795-807. doi: 10.1056/NEJMoa1506816
28. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipou MC, Kuma asamy N, e al. P e en ion o HIV-1
in ec ion wi h ea ly an i e o i al he apy. The New England Jou nal o Medicine. 2011; 365(6): 493-505. doi:
10.1056/NEJMoa1105243
29. Rodge AJ, Cambiano V, B uun T, Ve nazza P, Collins S, Degen O, e al. Risk o HIV ansmission h ough
condomless sex in se odi e en gay couples wi h he HIV-posi i e pa ne aking supp essi e an i e o i al he apy
(PARTNER): inal esul s o a mul icen e, p ospec i e, obse a ional s udy. The Lance . 2019; 393(10189): 2428-
2438. doi: 10.1016/S0140-6736(19)30418-0
30. UNAIDS. The pa h ha ends AIDS: UNAIDS global AIDS upda e 2023 [In e ne ]. Gene a: UNAIDS; 2023 [ci ed
2025 Jul 30]. A ailable om: h ps://www.unaids.o g/en/ esou ces/documen s/2023/2023-global-aids-upda e.
31. Eisinge RW, Die enbach CW, Fauci AS. HIV i al load and ansmissibili y o HIV in ec ion: unde ec able equals
un ansmi able. JAMA. 2019; 321(5): 451-452. doi: 10.1001/jama.2018.21167
32. Gazzino O, Do izio M, Sangio gi D, And e a M, Ba olini F, Ca alie e A, e al. Heal hca e esou ce consump ion
and ela ed cos s in pa ien s on an i e o i al he apies: indings om eal-wo ld da a in I aly. In e na ional Jou nal
o En i onmen al Resea ch and Public Heal h. 2023; 20(5): 3789. doi: 10.3390/ije ph20053789
33. Rodge AJ, Cambiano V, B uun T, Ve nazza P, Collins S, an Lunzen J, e al. Sexual ac i i y wi hou condoms and
isk o HIV ansmission in se odi e en couples when he HIV-posi i e pa ne is using supp essi e an i e o i al
he apy. JAMA. 2016; 316(2): 171-181. doi: 10.1001/jama.2016.5148
34. Decision Resou ces G oup Real-Wo ld Da a Reposi o y, 2024. Re ospec i e longi udinal s udy o elec onic
medical eco ds on pa ien weigh changes in SYMTUZA® s BIC/FTC/TAF (Bik a y) egimens in he US
(July 2017-Ma ch 2020). [online] A ailable h ough Sym uza® HCP po al.
35. Guinness L, Le ine R, Wea e M. 10 bes esou ces in...cos analysis o HIV/AIDS p og ammes in low and middle
income coun ies. Heal h Policy and Planning. 2004; 19(4): 242-245. doi: 10.1093/heapol/czh027
36. Hon elez JAC, Bo J, Tanse FC, Pillay D, Moshabela M, Bä nighausen T. HIV ea men subs an ially dec eases
hospi aliza ion a es: E idence om u al Sou h A ica. Heal h A (Millwood). 2018; 37(6): 997-1004. doi:
10.1377/ hl ha .2017.0820
