scholarly journals Very Low Incidence of HIV-infection and Decreasing Incidence of STI Among PrEP Users in 2020 After Introduction of Health Insurance Coverage in Germany

2022 ◽  
Author(s):  
Daniel Schmidt ◽  
Christian Kollan ◽  
Barbara Bartmeyer ◽  
Viviane Bremer ◽  
Tim Schikowski ◽  
...  
Keyword(s):  
Health Insurance ◽  
Hiv Infection ◽  
Insurance Coverage ◽  
Multivariable Analysis ◽  
Hiv Infections ◽  
Health Insurance Coverage ◽  
Incidence Rates ◽  
Factors Associated ◽  
Suboptimal Adherence ◽  
Low Incidence

Abstract IntroductionObjectives of this study, as part of a nation-wide HIV pre-exposure prophylaxis (PrEP) evaluation project, were to determine the incidence and prevalence of infections with HIV, Chlamydia, Gonorrhea, Syphilis, Hepatitis A/B/C in persons using PrEP, and to describe the health care funded PrEP use in Germany. Additionally, factors associated with Chlamydia/Gonorrhea and Syphilis infections were assessed.MethodsAnonymous data of PrEP users were collected at HIV-specialty centers from 09/2019-12/2020. Incidence rates were calculated per 100 person years (py). Logistic regression was used to analyze risk factors associated with sexually transmitted infections (STIs).Results4620 PrEP users were included: 99.2% male, median age 38 years (IQR 32-45), PrEP indication 98.6% men who have sex with men (MSM). Duration of PrEP use were 5132 py; median duration 451 days (IQR 357-488).Four HIV infections were diagnosed, incidence rate 0,078/100py (95% CI 0.029-0.208). For two suboptimal adherence was reported and in the third case suboptimal adherence and resistance to emtricitabine was observed. One infection was likely acquired before PrEP start.Incidence rates were 21.6/100py for Chlamydia, 23.7/100py for Gonorrhea, 10.1/100py for Syphilis and 55.4/100py for any STI and decreased significantly. 65.5% of Syphilis, 55.6% of Chlamydia and 50.1% of Gonorrhea cases were detected by screening of asymptomatic individuals. In a multivariable analysis among MSM younger age, PrEP start before health insurance coverage and daily PrEP were associated with greater risk for Chlamydia/Gonorrhea. Symptom triggered testing and a history of STI were associated with a higher risk for Chlamydia/Gonorrhea and Syphilis.ConclusionsWe found that HIV-PrEP is almost exclusively used by MSM in Germany. A very low incidence of HIV-infection and decreasing incidence rates of STIs were found in this cohort of PrEP users. The results were likely influenced by the SARS-CoV-2 pandemic. Rollout of PrEP covered by health insurance should be continued to prevent HIV infections. Increased PrEP availability to people at risk of HIV infection through the elimination of barriers requires further attention. Investigation and monitoring with a longer follow-up would be of value.

scholarly journals Correlates of health care access problems among reproductive age women in Ethiopia: In-depth analysis of 2016 Ethiopia demographic Health Survey

2019 ◽  
Author(s):  
koku Tamirat ◽  
Zemenu Tadesse Tessema ◽  
Fentahun Bikale Kebede
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Access ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Reproductive Age ◽  
Rural Residence ◽  
Factors Associated ◽  
Care Access ◽  
Reproductive Age Women

Abstract Background Health care access is timely use of personal health services to achieve best health outcomes. Difficulties to access health care among reproductive age women may led to different negative health outcomes to death and disability. Therefore, this study aimed to assess factors associated with problems of accessing health care among reproductive age women in Ethiopia.Method This study was based on 2016 Ethiopia Demography and Health Survey. Individual women record (IR) file was used to extract the dataset and 15, 683 women were included in the final analysis. A composite variable of problem of accessing health care were created from four questions used to rate problem of accessing health care among reproductive age women. Generalized estimating equation (GEE) model was fitted to identify factors associated with problem of accessing health care. Crude and Adjusted odds ratio with a 95%CI computed to assess the strength of association between independent and outcome variables.Result In this study the magnitude of problem in accessing health care among reproductive age women was 69.9% of with 95%CI (69.3 to 70.7). Rural residence (AOR= 2.13, 95%CI: 1.79 to 2.53), women age 35-49 years (AOR= 1.24, 95%CI: 1.09 to 1.40), married/live together (AOR= 0.72, 95%CI: 0.64 to 0.81), had health insurance coverage (AOR=0.83, 95%CI: 0.70 to 0.95), wealth index [middle (AOR=0.75,95%CI: 0.66 to 0.85) and rich (AOR=0.47,95%CI:0.42 to 0.53)], primary education(AOR= 0.80, 95%CI: 0.73 to 0.88), secondary education (AOR= 0.57, 95%CI:0.50 to 0.64) and diploma and higher education (AOR= 0.43, 95%CI: 0.37 to 0.50) were factors associated with problem of health care access among reproductive age women.Conclusion Despite better coverage of health system, problems of health care access among reproductive age women were considerably high. Health insurance coverage, middle and rich wealth, primary and above educational level were negatively associated with problems health care access. In contrast, older age and rural residence were positively associated with problems of health care access among reproductive age women. This suggests that further interventions are necessary to increase universal reproductive health care access for the achievement of sustainable development goals.

scholarly journals Factors Associated with National Health Insurance Coverage in Indonesia

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 563
Author(s):  
Tintin Sukartini ◽  
Hidayat Arifin ◽  
Yulia Kurniawati ◽  
Rifky Octavia Pradipta ◽  
Nursalam Nursalam ◽  
...  
Keyword(s):  
Health Insurance ◽  
Marital Status ◽  
National Health Insurance ◽  
National Health ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Education Level ◽  
Factors Associated ◽  
Number Of Children ◽  
Indonesian Population

Background: The National Health Insurance (NHI) program is the Indonesian government's national health program. However, health insurance coverage has not been maximized. This study aims to analyze the factors associated with health insurance coverage in Indonesia.   Methods: Cross-sectional data were obtained from the Indonesian Demographic and Health Survey 2017. A total of 39,580 respondents were selected using two-stage stratified cluster sampling. The data come from the DHS Questionnaire Phase 7. The variables include age, education level, wealth quintiles, residence, the number of children who are alive, marital status, current employment status, earnings, and health insurance status. The data were analyzed using chi-squared and binary logistic analyses.   Results: The prevalence of health insurance coverage in the Indonesian population is 62.3%. Respondent age [AOR=0.875; 95% CI=0.763-0.967], education level [AOR=0.437; 95% CI=0.410-0.466], wealth quintile [AOR=0.762; 95% CI=0.713-0.815], residence [AOR=0.762; 95% CI=0.713-0.815], marital status [AOR=0.718; 95% CI=0.625-0.825] and earnings [AOR=1.245; 95% CI=1.177-1.316] are related to health insurance coverage. However, the number of children who are alive and respondents who were currently working were not significantly related to health insurance coverage in Indonesia.  Conclusion: The government needs to pay attention to the characteristics and demographic conditions of the Indonesian population to be able to achieve maximum health insurance coverage. Maximum coverage through the provision of appropriate information should be promoted.

Linkage to HIV Medical Care and Social Determinants of Health Among Adults With Diagnosed HIV Infection in 41 States and the District of Columbia, 2017

2021 ◽  
pp. 003335492110299
Author(s):  
Myrline Gillot ◽  
Zanetta Gant ◽  
Xiaohong Hu ◽  
Anna Satcher Johnson
Keyword(s):  
Health Insurance ◽  
Hiv Infection ◽  
Medical Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Determinants Of Health ◽  
Hiv Care ◽  
Care Outcomes

Objectives To reduce the number of new HIV infections and improve HIV health care outcomes, the social conditions in which people live and work should be assessed. The objective of this study was to describe linkage to HIV medical care by selected demographic characteristics and social determinants of health (SDH) among US adults with HIV at the county level. Methods We used National HIV Surveillance System data from 42 US jurisdictions and data from the American Community Survey to describe differences in linkage to HIV medical care among adults aged ≥18 with HIV infection diagnosed in 2017. We categorized SDH variables into higher or lower levels of poverty (where <13% or ≥13% of the population lived below the federal poverty level), education (where <13% or ≥13% of the population had <high school diploma), and health insurance coverage (where <12% or ≥12% of the population lacked health insurance). We calculated prevalence ratios (PRs) and 95% CIs. Results Of 33 204 adults with HIV infection diagnosed in 2017, 78.4% were linked to HIV medical care ≤1 month after diagnosis. Overall, rates of linkage to care were significantly lower among men and women living in counties with higher versus lower poverty (PR = 0.96; 95% CI, 0.94-0.97), with lower versus higher health insurance coverage (PR = 0.93; 95% CI, 0.92-0.94), and with lower versus higher education levels (PR = 0.97; 95% CI, 0.96-0.98). Conclusions Increasing health insurance coverage and addressing economic and educational disparities would likely lead to better HIV care outcomes in these areas.

Predictors of Consumers’ Health Insurance Knowledge

2017 ◽  
Vol 28 (2) ◽  
pp. 300-312
Author(s):  
Sarah Osmane ◽  
Cathy Faulcon Bowen
Keyword(s):  
Health Insurance ◽  
Financial Literacy ◽  
Insurance Coverage ◽  
Binary Logistic Regression ◽  
Health Insurance Coverage ◽  
Consumer Health ◽  
Insurance Plan ◽  
Health Insurance Plan ◽  
Factors Associated ◽  
Tax Returns

The objectives of this study were to assess consumer knowledge of their health insurance plan and overall financial knowledge and to identify factors associated with consumer health insurance knowledge. A sample of taxpayers who had tax returns completed at a university-based volunteer income tax assistance (VITA) program was surveyed. More than 70% of respondents perceived their health insurance plan knowledge and overall financial literacy to be fair/good on a scale where the top choices were very good, excellent, and exceptional. The results of the binary logistic regression showed that those who were more likely to have high health insurance knowledge were U.S. citizens, not single, and reviewed their health insurance coverage at least once a year.

scholarly journals Counties with lower insurance coverage are associated with both slower vaccine rollout and higher COVID-19 incidence across the United States

2021 ◽  
Author(s):  
Emily Lindemer ◽  
Mayank Choudhary ◽  
Gregory Donadio ◽  
Colin Pawlowski ◽  
Venky Soundararajan
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Vaccination Rate ◽  
Incidence Rates ◽  
P Value ◽  
Spearman Correlation ◽  
Vaccination Rates ◽  
Vaccination Period

Efficient and equitable vaccination distribution is a priority for effectively outcompeting the transmission of COVID-19 globally. A recent study from the Centers for Disease Control and Prevention (CDC) identified that US counties with high social vulnerability according to metrics such as poverty, unemployment, low income, and no high school diploma, have significantly lower rates of vaccination compared to the national average1. Here, we build upon this analysis to consider associations between county-level vaccination rates and 68 different demographic, socioeconomic, and environmental factors for 1,510 American counties with over 228 million individuals for which vaccination data was also available. Our analysis reveals that counties with high levels of uninsured individuals have significantly lower COVID-19 vaccination rates (Spearman correlation: -0.264), despite the fact that the CDC has mandated that all COVID-19 vaccines are free and cannot be denied to anyone based upon health insurance coverage or immigration status. Furthermore, we find that the counties with high levels of uninsured individuals tend to have the highest COVID-19 incidence rates in March 2021 relative to December 2020 (Spearman correlation: 0.388). Among the 68 factors analyzed, insurance coverage is the only factor which is highly correlated with both vaccination rate and change in COVID-19 incidence during the vaccination period (|Spearman correlation| > 0.25). We also find that counties with higher percentages of Black and Hispanic individuals have significantly lower vaccination rates (Spearman correlations: -0.128, -0.136) and lesser declines of COVID-incidence rates (Spearman correlations: 0.334, 0.330) during the vaccination period. Surprisingly however, after controlling for race, we find that the association between lack of insurance coverage and vaccination rate as well as COVID-19 incidence rates is largely driven by counties with a majority white population. Among the counties with high proportions of white residents (top 10% decile), the association between insurance coverage and vaccination rate is significant (Spearman correlation: -0.210, p-value: 0.002), but among counties with low proportions of white residents (bottom 10% decile) this association is not significant (Spearman correlation: 0.072, p-value: 0.088). Taken together, this study highlights the fact that intricate socioeconomic factors are correlated not just to COVID-19 vaccination rates, but also to COVID-19 incidence fluctuations, underscoring the need to improve COVID-19 vaccination campaigns in marginalized communities. The strong positive correlation between low levels of health insurance coverage and low vaccination rates is particularly concerning, and calls for improved public health messaging to emphasize the fact that health insurance is not required to be eligible for any of the FDA-authorized COVID-19 vaccines in the United States.

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