Predictors of Health Insurance Enrollment among HIV Positive Pregnant Women in Kenya: Potential for Adverse Selection and Implications for HIV Treatment and Prevention
Abstract
:1. Introduction
2. Methods
3. Study Setting
4. Study Design and Sample
5. Variables
6. Statistical Analysis
7. Heterogeneous Effects
8. Results
Health Insurance Enrollment by HIV Severity
9. Discussion
10. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variables | EMR Sample Mean (SD) | Institutional Delivery Sample Mean (SD) | ||
---|---|---|---|---|
NHIF | Uninsured | NHIF | Uninsured | |
Current Age | 34.28 (5.96) | 33.39 (6.39) | 30.75 (4.95) | 30.97 (5.55) |
Age at Enrollment | 29.51 (5.61) | 29.03 (5.86) | 26.91 (4.47) | 27.42 (5.02) |
Age- First Pregnant @ AMPATH | 30.43 (5.92) | 29.80 (6.15) | 27.53 (4.74) | 28.05 (5.32) |
Ever Attended School (%) | 97.82 (16.29) | 92.17 (0.35) | 98.87 (10.6) | 99.30 (8.29) |
Years of Schooling Completed | 10.42 (3.10) | 7.92 (2.92) | 10.09 (2.86) | 7.94 (2.82) |
# of Pregnancies at Enrollment in AMPATH | 2.84 (1.72) | 3.47 (1.96) | 2.79 (1.29) | 3.37 (1.76) |
# of Children | 2.25 (1.64) | 3.01 (1.86) | 2.09 (1.43) | 2.74 (1.68) |
Enrolled Child at AMPATH (%) | 66.42 (47.89) | 68.06 (47.68) | 76.4 (42.70) | 79.45 (40.43) |
Lost to Follow-up—During Pregnancy (%) | 1.71 (16.67) | 1.00 (15.06) | 5.62 (23.16) | 1.55 (12.38) |
Currently on ARV Treatment | 86.94 (34.76) | 87.32 (33.28) | 88.76 (31.76) | 97.50 (15.63) |
CD4 @ Enrollment | 338.24 (247.14) | 359.24 (307.48) | 410.40 (255.90) | 396.49 (327.03) |
Travel Time (Hours) | 1.97 (0.99) | 2.05 (0.98) | 1.89 (0.94) | 2.00 (0.95) |
# Days Pre ARV Initiation | 286.46 (475.11) | 271.15 (429.65) | 262.07 (354.62) | 227.13 (354.62) |
# Days Post ARV Initiation | 1828.68 (876.28) | 1635.62 (784.12) | 1535.34 (952.05) | 1427.11 (768.71) |
Urban Clinic (%) | 70.06 (47.59) | 44.80 (50.0) | 69.70 (46.23) | 42.06 (49.39) |
Observations | 1997 (15.86%) | 10596 (84.14%) | 89 (7.25%) | 1159 (92.75%) |
Overall N | 12,593 | 1248 |
Predictors | Bivariate Analysis | ||
---|---|---|---|
Odds Ratio | 95% CI | p-Value | |
Delivered at Health Institution | 2.91 (0.92) | 1.56–5.41 | 0.00 *** |
Current Age | 0.99 (0.02) | 0.96–1.03 | 0.67 |
Age at Enrollment | 0.98 (0.02) | 0.94–1.02 | 0.02 ** |
Age at First Pregnancy at AMPATH | 0.98 (0.02) | 0.95–1.02 | 0.32 |
Ever Attended School | 0.61 (0.65) | 0.08–4.95 | 0.65 |
Years of Schooling Completed | 1.32 (0.06) | 1.22–1.44 | 0.00 *** |
# of Pregnancies at Enrollment in AMPATH | 0.80 (0.05) | 0.71–0.91 | 0.00 *** |
Number of Children | 0.76 (0.06) | 0.65–0.88 | 0.00 *** |
Enrolled Child in AMPATH | 0.84 (0.22) | 0.50–1.40 | 0.50 |
Lost to Follow-up—During Pregnancy | 3.77 (1.95) | 1.37–10.41 | 0.01 ** |
Currently on ARV Treatment | 0.21 (0.08) | 0.10–0.43 | 0.00 *** |
CD4 at Enrollment | 1.00 (0.00) | 0.99–1.00 | 0.61 |
# Days Pre ARV Initiation | 1.00 (0.00) | 0.99–1.00 | 0.33 |
# Days Post ARV Initiation | 1.00 (0.00) | 0.99–1.00 | 0.29 |
Travel Time (Hours) | 0.89 (0.11) | 0.69–1.12 | 0.29 |
Enrolled in an Urban Clinic | 3.16 (0.75) | 1.98–5.05 | 0.00 *** |
Predictors | Multivariate Analysis | ||
---|---|---|---|
Odds Ratio | 95% CI | p-Value | |
Delivered at Health Institution | 2.46 (0.86) | 1.24–4.87 | 0.01 ** |
Current Age | 0.52 (0.13) | 0.31–0.86 | 0.01 ** |
Age at Enrollment | 2.24 (0.62) | 1.30–3.86 | 0.00 *** |
Age at First Pregnancy at AMPATH | 0.86 (0.08) | 0.72–1.02 | 0.09 * |
Ever Attended School | 0.10 (0.12) | 0.01–0.91 | 0.04 ** |
Years of Schooling Completed | 1.28 (0.06) | 1.16–1.40 | 0.00 *** |
# of Pregnancies at Enrollment in AMPATH | 0.91 (0.14) | 0.68–1.22 | 0.54 |
Number of Children | 1.01 (0.19) | 0.70–1.45 | 0.98 |
Enrolled Child in AMPATH | 0.78 (0.24) | 0.43–1.41 | 0.40 |
Lost to Follow-up – During Pregnancy | 9.90 (5.37) | 3.42–28.67 | 0.00 *** |
Currently on ARV Treatment | 0.22 (0.09) | 0.10–0.49 | 0.00 *** |
CD4 at Enrollment | 1.00 (0.00) | 0.99–1.00 | 0.41 |
# Days Pre ARV Initiation | 1.00 (0.00) | 1.00–1.00 | 0.00 *** |
# Days Post ARV Initiation | 1.00 (0.00) | 1.00–1.00 | 0.00 *** |
Travel Time (Hours) | 1.02 (0.14) | 0.79–1.33 | 0.87 |
Enrolled in an Urban Clinic | 2.50 (0.63) | 1.53–4.12 | 0.00 *** |
Predictors | CD4 ≤ 350 | CD4 > 350 | ||||
---|---|---|---|---|---|---|
Odds Ratio | 95% CI | p-Value | Odds Ratio | 95% CI | p-Value | |
Delivered at Health Institution | 3.69 | 1.15–11.82 | 0.03 ** | 1.82 | 0.75–4.45 | 0.19 |
Current Age | 0.49 | 0.22–1.08 | 0.08 * | 0.50 | 0.25–1.02 | 0.06 * |
Age at Enrollment | 2.16 | 0.94–4.94 | 0.07 * | 2.92 | 1.20–7.08 | 0.02 ** |
Age at First Pregnancy at AMPATH | 0.92 | 0.75–1.13 | 0.41 | 0.70 | 0.48–1.01 | 0.06 * |
Ever Attended School | 1.00 | 0.56–1.32 | 0.89 | 0.02 | 0.00–0.33 | 0.01 ** |
Years of Schooling Completed | 1.10 | 0.97–1.25 | 0.13 | 1.48 | 1.28–1.71 | 0.00 *** |
# of Pregnancies at Enrollment in AMPATH | 1.00 | 0.65–1.53 | 0.98 | 0.83 | 0.53–1.29 | 0.41 |
Number of Children | 1.03 | 0.62–1.73 | 0.91 | 1.02 | 0.57–1.82 | 0.96 |
Enrolled Child in AMPATH | 0.65 | 0.26–1.62 | 0.36 | 0.91 | 0.37–2.23 | 0.83 |
Lost to Follow-up—During Pregnancy | 3.06 | 0.61–15.18 | 0.17 | 17.42 | 3.52–86.29 | 0.00 *** |
Currently on ARV Treatment | 0.03 | 0.00–0.32 | 0.00 *** | 0.48 | 0.17–1.38 | 0.18 |
# Days Pre ARV Initiation | 1.00 | 0.99–1.00 | 0.12 | 1.00 | 1.00–1.00 | 0.01 ** |
# Days Post ARV Initiation | 1.00 | 1.00–1.01 | 0.03 ** | 1.00 | 1.00–1.01 | 0.02 ** |
Travel Time (Hours) | 1.24 | 0.80–1.93 | 0.33 | 0.84 | 0.60–1.17 | 0.30 |
Enrolled in an Urban Clinic | 5.71 | 2.40–13.6 | 0.00 *** | 1.19 | 0.61–2.31 | 0.62 |
N (Sample Size) | 640 | 607 |
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Were, L.P.O.; Hogan, J.W.; Galárraga, O.; Wamai, R. Predictors of Health Insurance Enrollment among HIV Positive Pregnant Women in Kenya: Potential for Adverse Selection and Implications for HIV Treatment and Prevention. Int. J. Environ. Res. Public Health 2020, 17, 2892. https://doi.org/10.3390/ijerph17082892
Were LPO, Hogan JW, Galárraga O, Wamai R. Predictors of Health Insurance Enrollment among HIV Positive Pregnant Women in Kenya: Potential for Adverse Selection and Implications for HIV Treatment and Prevention. International Journal of Environmental Research and Public Health. 2020; 17(8):2892. https://doi.org/10.3390/ijerph17082892
Chicago/Turabian StyleWere, Lawrence P.O., Joseph W Hogan, Omar Galárraga, and Richard Wamai. 2020. "Predictors of Health Insurance Enrollment among HIV Positive Pregnant Women in Kenya: Potential for Adverse Selection and Implications for HIV Treatment and Prevention" International Journal of Environmental Research and Public Health 17, no. 8: 2892. https://doi.org/10.3390/ijerph17082892