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Among the 941 PLWH in this study, 83.00% (781/941) were male. Of these, 48.88% (460/941) were 18–39 years old, and the median (IQR) age was 41 (33–53) years. Further, 21.57% (203/941) were senior high school or technical secondary school students, and 31.24% (294/941) were undergraduates or above. A total of 37.62% (354/941) of the participants were married. A total of 17.00% (160/941) frequently worked away from their hometowns. Homosexual HIV transmission was observed in 51.54 % (485/941) of participants. Moreover, 49.10% (462/941) had a personal annual income at the level of ≤ 49,999 CNY, and the median (IQR) personal annual income was at the level of 40,000 (20,000–60,000) CNY (Table 1).
Variables Number(N) Percentage (%) Total 941 100.00 Gender Male 781 83.00 Female 160 17.00 Age, years Median (IQR) 41(33-53) 18– 460 48.88 40– 365 38.79 ≥ 60 116 12.33 Ethnicity Han 900 95.64 Others 41 4.36 Education Elementary school or below 140 14.88 Junior high school 304 32.31 Senior high school or technical secondary school 203 21.57 Undergraduate or above 294 31.24 Marital status Divorced or widowed 166 17.64 Unmarried 421 44.74 Married 354 37.62 Occupation Unemployed/Retired 231 24.55 Off-farm workers 241 25.61 Private/Foreign enterprise employees 298 31.67 Government agency/Public institution/State-owned enterprise employees 90 9.56 Others 81 8.61 Type of basic medical insurance Basic medical insurance for urban and rural residents 435 46.2 Basic medical insurance for urban employees 383 40.7 Others 123 13.1 Year of confirmation of HIV infection 2020–2022 201 21.36 2017–2019 323 34.32 2014–2016 245 26.04 2011–2013 111 11.80 –2010 61 6.48 Whether frequently worked away from hometown No 781 83.00 Yes 160 17.00 Route of transmission Heterosexual transmission 396 42.08 Homosexual transmission 485 51.54 Others 60 6.38 Average annual income of family members, CNY Median (IQR) 25,000 (12,500–45,833) ≤ 49,999 709 75.35 50,000– 169 17.96 ≥ 100,000 63 6.69 Personal annual income, CNY Median (IQR) 40,000 (20,000–60,000) ≤ 49,999 462 49.10 50,000– 311 33.05 ≥ 100,000 168 17.85 A recipient of government medical aid No 836 88.84 Yes 105 11.16 Main sources of income Own income 745 79.17 Assistance from others 131 13.92 Others 65 6.91 Level of ART hospital County hospitals or below 317 33.69 Municipal hospitals 444 47.18 Provincial hospitals 180 19.13 Adverse events of antiretroviral drugs No 716 76.09 Yes 225 23.91 Concerned about privacy No 92 9.78 Yes 849 90.22 Willingness to pay for antiretroviral drugs covered by medical insurance No 670 71.20 Yes 271 28.80 Note. Abbreviations: IQR, interquartile range; HIV, human immunodeficiency virus; CNY, Chinese Yuan; ART, antiretroviral therapy. Table 1. General characteristics of the participants
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Among the 941 PLWH included in this study, 47.18% (444/941) received treatment at municipal hospitals and 19.13% (180/941) at provincial hospitals. Furthermore, 23.91% (225/941) experienced adverse events of antiretroviral drugs, and 90.22% (849/941) were concerned about privacy regarding their HIV status (Table 1).
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Among the 941 PLWH included in this study, 271 (28.80%) were willing to pay for antiretroviral drugs covered by medical insurance. For basic medical insurance for urban and rural residents, PLWH with the following characteristics were more willing to pay: having an education level of senior high school or technical secondary school (aOR = 7.19; 95% CI: 2.01–25.72), having an undergraduate degree or above (aOR = 7.03; 95% CI: 1.85–26.66); frequently worked away from their hometown (aOR = 6.23; 95% CI: 3.06–12.71); and homosexual transmission (aOR = 3.05; 95% CI: 1.61–5.78). Furthermore, PLWH with the following characteristics were more unwilling to pay for antiretroviral drugs covered by medical insurance: off-farm workers (aOR = 0.34; 95% CI: 0.14–0.83) and recipients of government medical aid (aOR = 0.27; 95% CI: 0.08–0.94) (Table 2).
Variable Basic medical insurance for urban and rural residents Basic medical insurance for urban employees OR (95% CI) aOR (95% CI) OR (95% CI) aOR (95% CI) Gender Male 1.00 1.00 Female 0.56 (0.31–1.03) 0.38 (0.15–0.94)* Age, years 18–39 1.00 1.00 40–59 0.39 (0.23–0.66)*** 0.50 (0.32–0.79)** ≥ 60 0.21 (0.08–0.55)** 0.39 (0.18–0.84)* Ethnicity Others 1.00 1.00 Han 0.38 (0.15–1.01) 1.25 (0.37–4.24) Education Elementary school or below 1.00 1.00 1.00 Junior high school 2.65 (0.88–8.01) 2.01 (0.57–7.17) 1.81 (0.88–4.01) Senior high school or technical secondary school 10.41 (3.50–30.98)*** 7.19 (2.01–25.72)** 0.52 (0.24–1.11) Undergraduate or above 15.05 (4.95–45.79)*** 7.03 (1.85–26.66)** 1.12 (0.59–2.13) Marital status Divorced or widowed 1.00 1.00 Unmarried 4.18 (1.94–9.01)*** 4.07 (2.00–8.27)*** Married 1.29 (0.58–2.89) 2.38 (1.13–5.05)* Occupation Unemployed/Retired 1.00 1.00 1.00 Off-farm workers 0.60 (0.30–1.22) 0.34 (0.14–0.83)* 0.69(0.33–1.45) Private/Foreign enterprise employees 1.41 (0.74–2.67) 0.54 (0.24–1.25) 1.29(0.73–2.28) Government agency/Public institution/State-owned enterprise employees 4.87 (1.89–12.57)** 2.32 (0.73–7.43) 1.91(0.96–3.79) Others 1.95 (0.82–4.60) 0.64 (0.23–1.79) 0.62 (0.22–1.74) Year of confirmation of HIV infection 2020–2022 1.00 1.00 2017–2019 0.93 (0.50–1.72) 0.94 (0.50–1.76) 2014–2016 0.90 (0.45–1.78) 0.87 (0.46–1.62) 2011–2013 0.69 (0.28–1.67) 1.05 (0.49–2.25) –2010 0.66 (0.21–2.10) 0.29 (0.10–0.87)* Whether frequently worked away from hometown No 1.00 1.00 1.00 1.00 Yes 5.68 (3.24–9.98)*** 6.23 (3.06–12.71)*** 3.64 (2.14–6.18)*** 3.22 (1.83–5.68)*** Route of transmission Heterosexual transmission 1.00 1.00 1.00 1.00 Homosexual transmission 4.74 (2.80–8.03)*** 3.05 (1.61–5.78)*** 2.91 (1.80–4.69)*** 2.20 (1.26–3.84)** Others 1.30 (0.71–2.29) 0.65 (0.32–1.28) 1.07 (0.36–3.17) 1.05 (0.33–3.33) Average annual income of family members, CNY ≤ 49,999 1.00 1.00 50,000–99,999 4.65 (2.30–9.41)*** 2.06 (1.29–3.29)** ≥ 100,000 4.26 (1.53–11.88)** 2.71 (1.37–5.36)** A recipient of government medical aid No 1.00 1.00 1.00 Yes 0.33 (0.12–0.94)* 0.27 (0.08–0.94)* 0.68 (0.31–1.46) Personal annual income, CNY ≤ 49,999 1.00 1.00 1.00 50,000–99,999 3.80 (2.21–6.54)*** 1.79 (1.04–3.06)* 1.50 (0.84–2.70) ≥ 100,000 3.75 (1.80–7.82)*** 3.78 (2.12–6.73)*** 3.08 (1.66–5.74)*** Main sources of income Own income 1.00 1.00 Assistance from others 0.80 (0.44–1.46) 0.25 (0.06–1.12) Others 1.32 (0.57–3.08) 0.46 (0.17–1.30) Level of ART hospital County hospitals or below 1.00 1.00 Municipal hospitals 0.35 (0.20–0.60)*** 0.88 (0.54–1.42) Provincial hospitals 0.74 (0.37–1.47) 1.52 (0.90–2.58) Adverse events of antiretroviral drugs No 1.00 1.00 1.00 Yes 2.87 (1.69–4.87)*** 1.66 (1.05–2.64)* 1.71 (1.03–2.85)* Concerned about privacy No 1.00 1.00 Yes 0.65 (0.34–1.26) 1.61 (0.69–3.75) Note. *P < 0.05, **P < 0.01,***P < 0.001; WTP, willingness to pay; PLWH, people living with human immunodeficiency virus; HIV, human immunodeficiency virus; CNY, Chinese Yuan; ART, antiretroviral therapy. Table 2. Factors associated with WTP for antiretroviral drugs covered by medical insurance among PLWH
For basic medical insurance for urban employees, PLWH with the following characteristics were more willing to pay: frequently worked away from their hometowns (aOR = 3.22; 95% CI: 1.83–5.68); homosexual transmission (aOR = 2.20; 95% CI: 1.26–3.84); personal annual income at the level of ≥ 100,000 CNY (aOR = 3.08; 95% CI: 1.66–5.74); and adverse events of antiretroviral drugs (aOR = 1.71; 95% CI: 1.03–2.85) (Table 2).
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According to the results of in-depth interviews with nine PLWH, the main reasons for PLWH’s WTP for antiretroviral drugs covered by medical insurance were that the drugs had fewer adverse events and were easier to take. The main reasons for PLWH’s unwillingness to pay were financial difficulties and privacy concerns regarding their HIV status.
Whether willing to pay for antiretroviral drugs covered by medical insurance Main reason Representative quotations Yes Fewer adverse events I didn’t sleep well when I started taking the free antiretroviral drugs. Next year, I will buy antiretroviral drugs covered by medical insurance, so that my body will suffer fewer adverse events. (SC2022120701) If there are adverse events from taking free antiretroviral drugs, I am willing to pay for antiretroviral drugs covered by medical insurance. (JS2022081801) One advantage of antiretroviral drugs covered by medical insurance is that they have less side effects on the liver and kidneys, and fewer adverse events such as dizziness, nightmares, and diarrhea. (GD2022120701) Easier to take Antiretroviral drugs covered by medical insurance are easier to take, and are taken once a day and only one pill at a time. Free antiretroviral drugs are troublesome to take, and have to be taken twice a day and three pills at a time. (HN2022120701) No Financial difficulties I earn just over 1,000 CNY a month and I would only consider using antiretroviral drugs covered by medical insurance when the out-of-pocket is about 100 CNY a month. (HN2022092802) I am unemployed right now and facing financial difficulties. If I can get a stable job in the future, I will turn to antiretroviral drugs covered by medical insurance. (SC2022120702) I’m taking free antiretroviral drugs right now. Many PLWH like me suffer from adverse events such as depression, nightmares, and hyperlipidemia. However, we still insist on taking free antiretroviral drugs, because of our own financial difficulties. If the price of antiretroviral drugs covered by medical insurance fell further, more people might be willing to pay for it. (LN2022092201) Privacy concerns I’m especially concerned about whether it is possible that the medical insurance administrations reveal my private data once they get the information related to my condition. In addition, I am also worried that the medical insurance administrations will let my workplace to know about my details. So, I am unwilling to pay for antiretroviral drugs covered by medical insurance. (CQ2022121701) I work in a state-owned enterprise and have a decent income. However, I am unwilling to pay for antiretroviral drugs covered by medical insurance for fear of privacy disclosure. (JS2022081802) Note. WTP, willingness to pay; PLWH, people living with human immunodeficiency virus; CNY, Chinese Yuan; SC, Sichuan Province; JS, Jiangsu Province; GD, Guangdong Province; HN, Hunan Province; LN, Liaoning Province; CQ, Chongqing Municipality. Table 3. In-depth interview results regarding WTP for antiretroviral drugs covered by medical insurance among PLWH
Willingness to Pay for Antiretroviral Drugs Covered by Medical Insurance among People Living with HIV in 18 Chinese Cities
doi: 10.3967/bes2024.105
- Accepted Date: 2024-05-07
Abstract:
The authors declare no conflicts of the interest related to this study.
Citation: | HU Jing Kun, TANG Hou Lin, KANG Wen Ting, WANG Shu Yu, XU Jie, ZHAO De Cai, HAO Yang, WANG Xin Lun, LYU Fan, ZHANG Guang, XU Peng. Willingness to Pay for Antiretroviral Drugs Covered by Medical Insurance among People Living with HIV in 18 Chinese Cities[J]. Biomedical and Environmental Sciences. doi: 10.3967/bes2024.105 |