Determinants of willingness to participate in community-based health insurance among People Living with HIV in South-East Nigeria

Abstract

Background: Despite free antiretroviral treatment at designated facilities, many People Living with HIV (PLHIV) in Nigeria continue to face catastrophic health expenditures (CHE) due to direct non-medical and indirect costs of illness. Waning donor funding and poor country ownership of HIV care programs are challenges to the sustainability of care for PLHIV. Community-Based Health Insurance (CBHI) presents a viable alternative for funding HIV care services. The aim of this study was to assess the determinants of Willingness To Participate (WTP) in CBHI among PLHIV in a large tertiary hospital in South-east Nigeria. Methods and materials: A cross-sectional survey was conducted among 371 PLHIV on treatment at Federal Teaching Hospital Abakaliki Nigeria using an interviewer-administered questionnaire. Descriptive, bivariate and multivariate logistic regression analyses were conducted using SPSS version 20. Statistical tests were conducted at 5% level of significance. Results: Respondents were mostly males (51.8%) with mean age of 45.4 ± 10.3. The mean monthly income of respondents was N26, 665.77 ± 15,171.50 ($74,070 ± 42.14). Majority were willing to participate (825%) and to finance their participation in CBHI (65.2%). Major reasons given for unwillingness to participate in CBHI were poor understanding on how the system works, lack of regular source of income, health insurance not needed and fear of poor management of resources. On bivariate analysis, WTP in CBHI was associated with gender (p < 0.001), marital status (p < 0.001), employment type (p = 0.006), family size (p = 0.001), educational level (p < 0.001), monthly and monthly income (p < 0.001). Predictors of WTP were female gender (AOR = 2.9; 95% CI: 1.6–5.7), being currently unmarried (AOR = 4.3; 95% CI: 2.3–7.8), self-employed (AOR = 2.2; 95% CI: 1.2–3.9), family size greater than 5 (AOR = 3.1; 95% CI: 1.7–5.9) and having less than a secondary school education (AOR = 4.3; 95% CI: 2.3–7.8). Conclusion: The majority of the respondents were willing to participate and finance their participation in CBHI. The vulnerable subgroups (females, unmarried, self-employed, poorly educated and those with large family size) had higher odds of WTP. To reduce CHE, there is a need to harness this high WTP among PLHIV in the design of subsidized and sustainable CBHI programs with special focus on the socially disadvantaged.