Sustainability of Donor-Supported HIV Prevention Services : A Mixed Methods Study of the Ability and Willingness to Pay for Voluntary Medical Male Circumcision in Uganda

Byabagambi, John and Hollingsworth, Bruce and Limmer, Mark (2024) Sustainability of Donor-Supported HIV Prevention Services : A Mixed Methods Study of the Ability and Willingness to Pay for Voluntary Medical Male Circumcision in Uganda. PhD thesis, Lancaster University.

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Abstract

Uganda faces a generalised HIV epidemic, with about 1.2 million people living with HIV and AIDS. Uganda’s HIV response is primarily donor funded, with 88% of funds from international donors. This PhD thesis focused on identifying potential alternative sources of funding for voluntary medical male circumcision (VMMC), which is one of the WHO-approved HIV prevention interventions. A systematic review of the willingness to pay (WTP) for HIV and AIDS in Africa was conducted as part of the thesis, and it revealed that there was an opportunity to fund the HIV response through out-of-pocket payments more sustainably. Informed by the systematic review, a mixed-methods, cross-sectional study was conducted with three objectives. The first was to determine the factors associated with the ability to pay (ATP) for VMMC, and it revealed that increasing age and having a university-level education are positively associated with the ability to pay while residing in a rural area and having high perceived behaviour control are negatively associated with the ATP for VMMC. The second objective was to determine the factors associated with WTP for VMMC. The findings revealed that 76% of the respondents were willing to pay for VMMC. The factors positively influencing WTP for VMMC are the ability to pay and belonging to the Muslim faith. Residing in a rural area, having no education and increasing perceived behaviour control are negatively associated with WTP for VMMC. The third and final objective was to identify the factors that inform WTP decisions. Twenty-nine qualitative interviews were completed, revealing mixed findings for and against paying for VMMC. This PhD contributes to the knowledge of willingness to pay for HIV services and documents key considerations for the successful introduction and implementation of fee-for-service VMMC. Further, the study improves the use of WTP methodology in health research. Overall policy implications are drawn in the Conclusions