Analysis of PLWH switching to medical insurance ART: a cross-sectional study in six Chinese provinces

Antiretroviral therapy (ART) security policy in China has entered a new stage of diversification, and there are free ART, medical insurance ART, self-funded ART. In recent years, some people living with human immunodeficiency virus(PLWH) have switched to medical insurance ART from free ART. Therefore, this study analyzed the information of those PLWH to provide reference for improving ART security policy in China.

A cross-sectional survey was used to collect the general characteristics, economic status, and ART status of PLWH from 18 cities in 6 provinces. The Chi-square test was used to analyse whether the differences between PLWH who switched to medical insurance ART and those who did not were statistically significant. Multivariable logistic regression was used to analyse the factors associated with switching to medical insurance ART.

Among the 1371 participants, 17.3% switched to medical insurance ART. The differences between PLWH who switched to medical insurance ART and those who did not were statistically significant (p < 0.05) in education, occupation, type of basic medical insurance, average annual income of family members, personal annual income, changes in personal annual income, whether is the government medical aid recipient or households registered as living under the poverty line, year of initiating ART, level of ART hospital, distance to ART hospital, and whether adverse medicine reactions occur. Government agency/public institution/state-owned enterprise employees (aOR = 2.34, 95% CI: 1.29-4.26), basic medical insurance for urban employed (aOR = 1.93, 95% CI: 1.28-2.90), average annual income of family members were ≥ $13,972 (aOR = 2.12, 95% CI: 1.27-3.54), personal annual income were ≥ $13,972 (aOR = 2.39, 95% CI: 1.43-4.00), initiated ART before 2012 (aOR = 1.67, 95% CI: 1.02-2.75), provincial hospitals (aOR = 2.00, 95% CI: 1.30-3.09) were factors associated with switching to medical insurance ART.

17.3% PLWH switched to medical insurance ART, indicating the attractiveness of medical insurance ART. The characteristics of PLWH who switched to medical insurance ART and the factors associated with switching should be fully considered, so as to provide targeted ART services and improve ART security policy in China.