The triple impact of economic hardship, insecurity, and flooding on access to antiretroviral therapy: a focus on people living with HIV/AIDS in Maiduguri, Nigeria

Background: The multifaceted impact of economic hardship, insecurity, and flooding on access to antiretroviral therapy (ART) among people living with HIV/AIDS (PLHIV) in Maiduguri, Nigeria is highlighted by this article. While ART has transformed HIV from a fatal condition to a manageable chronic illness, achieving consistent access in regions facing socioeconomic and environmental challenges such as Maiduguri remains a critical issue. Factors such as inflation, poverty, and high transportation costs hinder PLHIV’s ability to obtain treatment and related medical services. Although antiretroviral drugs are subsidised in Nigeria, associated costs, including transport-fare and laboratory fees, place a significant burden on patients. This financial strain disrupts adherence to treatment, risking clinical failures and drug resistance. Insecurity due to the Boko Haram insurgency exacerbates these challenges. Methods: A comprehensive literature search was conducted using keywords such as ART, economic hardship, Maiduguri, flooding, and insecurity to identify relevant articles from Scopus, PubMed, and Google Scholar. Boolean operators "AND" and "OR" were applied to construct precise search strings, ensuring broad yet targeted retrieval of relevant studies. A total of 27 articles were included based on their relevance, methodological quality, and contribution to the study's aim. Eligible publications encompassed original research, systematic and narrative reviews, meta-analyses, perspectives, and grey literature, with priority given to studies published in English within the last ten years. A snowballing bibliometric approach was also employed to identify additional relevant literature. Full-text articles were critically analyzed and narratively synthesized under appropriate subheadings. Conclusion: There is an urgent need for comprehensive strategies that address these interlinked issues. Bolstering healthcare infrastructure, developing climate-resilient HIV prevention strategies, and enhancing policy frameworks for emergency health response, strengthening government coordination and securing both local and international support are vital for sustaining ART access. These could assist to improving health outcomes for vulnerable populations such as PLHIV in conflict and disaster-affected areas like Maiduguri.