Barriers to social health insurance enrollment for accessing antiretroviral therapy among people living with HIV/AIDS at early stages of shifting to insurance-based systems: a narrative literature review

Abstract

Introduction: Global funding for human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) responses in low- and middle-income countries is decreasing, and becomes unpredictable in the future due to co-existing pandemic of COVID-19. Therefore, lessons learned from a developing country that successfully shifted HIV/AIDS programs to insurance-based systems are in need. Aim of the study was to identify the barriers to enrollment and the use of health insurance (HI) for antiretroviral therapy (ART) in Vietnam. Material and methods: This study is a narrative literature assessment of peer-reviewed publications on HI for accessing ART in Vietnam. Conceptual framework was developed based on the study's objectives with related factors analyzed from user's perspective, provider's perspective, and socioeconomic and cultural factors considered. Results: From user's perspective, the barriers to HI enrollment and the use of HI included awareness of the benefits from HI, affordability for enrollment into HI, fear of stigma and discrimination, fear of responsibility to pay for co-payment, and pre-conception of services provided by HI. From provider's perspective, the barriers were health workers' attitudes, quality of care and treatment services as well as inconsistent and insufficient guidance on social health insurance coverage of care and treatment for people living with HIV (PLHIV). Conclusions: A comprehensive information package on HI and the benefits of HIV/AIDS services integrated into HIV programs should be considered to improve the enrollment into and the use of HI among PLHIV. Additionally, it is very important to encourage the government and local authorities to secure adequate funds for co-payment of ART.