Alo Chihurumnanya Nwachi, Okedo-Alex Ijeoma Nkem, Akamike Ifeyinwa Chizoba
Department of Community Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
Niger Postgrad Med J. 2020 Jul-Sep;27(3):196-201. doi: 10.4103/npmj.npmj_11_20.
Waning donor funding and poor country ownership of HIV care programmes are challenges for the sustainability of care for people living with HIV (PLHIV) in Nigeria. Health insurance presents a viable alternative for funding of HIV care services. This study assessed the determinants of willingness to participate in health insurance amongst PLHIV in a tertiary hospital in South-East Nigeria.
Across-sectional survey was conducted amongst 371 PLHIV on treatment at Federal Teaching Hospital, Abakaliki, Nigeria, using a semi-structured, interviewer-administered questionnaire. Chi-square test and logistic regression were conducted with SPSS version 20 at 5% level of significance.
Respondents were mostly males (51.8%) with a mean age and monthly income of 45.4 ± 10.3 years and $74.1 ± 42, respectively. Majority were willing to participate (82.5%) and to finance health insurance (65.2%). The major reasons cited by those unwilling to participate were poor understanding of how the system works and lack of regular source of income. The predictors of willingness to participate were female gender (adjusted odds ratio [AOR] = 2.9; 95% confidence interval [CI]: 1.6-5.7), being currently unmarried (AOR = 4.3; 95% CI: 2.3-7.8), being self-employed (AOR = 2.2; 95% CI: 1.2-3.9), having family size >5 (AOR = 3.1; 95% CI: 1.7-5.9) and having less than secondary school education (AOR = 4.3; 95% CI: 2.3-7.8).
Majority of the respondents surveyed were willing to participate in, and finance health insurance. Willingness to participate was more amongst vulnerable subgroups (females, unmarried, self-employed, poorly educated and those with large family size). We recommend the inclusion of health insurance in the care package of PLHIV.
捐赠资金减少以及尼日利亚对艾滋病护理项目的国家自主权不足，是该国艾滋病病毒感染者（PLHIV）护理可持续性面临的挑战。医疗保险是为艾滋病护理服务提供资金的可行选择。本研究评估了尼日利亚东南部一家三级医院中艾滋病病毒感染者参与医疗保险意愿的决定因素。
在尼日利亚阿巴卡利基联邦教学医院接受治疗的371名艾滋病病毒感染者中进行了一项横断面调查，使用半结构化、由访谈员管理的问卷。使用SPSS 20版本在5%的显著性水平下进行卡方检验和逻辑回归。
受访者大多为男性（51.8%），平均年龄和月收入分别为45.4±10.3岁和74.1±42美元。大多数人愿意参与（82.5%）并为医疗保险付费（65.2%）。不愿参与的主要原因是对该系统的运作方式了解不足以及缺乏固定收入来源。参与意愿的预测因素为女性（调整后的优势比[AOR]=2.9；95%置信区间[CI]：1.6-5.7）、目前未婚（AOR=4.3；95%CI：2.3-7.8）、个体经营（AOR=2.2；95%CI：1.2-3.9）、家庭规模>5（AOR=3.1；95%CI：1.7-5.9）以及教育程度低于中学（AOR=4.3；95%CI：2.3-7.8）。
大多数接受调查的受访者愿意参与并为医疗保险付费。弱势群体（女性、未婚、个体经营、教育程度低和家庭规模大的人）中参与意愿更高。我们建议将医疗保险纳入艾滋病病毒感染者的护理套餐中。
