Health insurance for people living with HIV in Ogun State, Southwest Nigeria: coverage, determinants and barriers: a cross-sectional study

The sustainability of Nigeria’s HIV response is currently threatened by dwindling donor funds and the rising prevalence of Non-communicable Diseases (NCDs) among People living with HIV (PLHIV), necessitating efforts to improve domestic funding for HIV and secure overall health-related financial risk protection for PLHIV. Health insurance offers opportunities for domestic financing to promote the sustainability of Nigeria’s HIV response and to prevent catastrophic health expenditure for individuals living with HIV-NCD comorbidities. Therefore, this study assessed health insurance coverage and its determinants among PLHIV, as well as barriers to coverage, in a southwestern state in Nigeria. This cross-sectional study used a semi-structured questionnaire to elicit responses from PLHIV aged ≥ 18 years accessing antiretroviral treatment services in Ogun State, Nigeria. We adopted a multi-stage sampling technique based on healthcare facility type to select respondents. The main outcome variable was health insurance coverage status, while the independent variables included respondents’ socioeconomic, demographic, and health characteristics. Chi-square tests and binary logistic regression with respective odds ratios were conducted at the bivariable and multivariable levels, respectively, to examine the relationship between health insurance coverage and the independent variables. Of the 992 respondents, only 8.6% had health insurance coverage. Those who had completed tertiary education (AOR = 4.89, 95% CI: 1.59–14.98), those with a monthly household income > ₦100,000 (AOR = 2.81, 95% CI: 1.12–7.04), and homeowners (AOR = 2.15, 95% CI: 1.24–3.72) had higher odds of being enrolled in a health insurance scheme. Regarding barriers to health insurance coverage, about one-quarter of participants reported never having heard of health insurance (23.7%) and being unable to afford the required premium for existing health insurance schemes (26.0%). This study highlights low health insurance coverage among PLHIV, with poor knowledge and poor affordability of health insurance schemes as major barriers to coverage. Health insurance awareness and demand creation efforts in Nigeria need to be re-engineered and tailored to reach more PLHIV, and health insurance models that promote equity should be embraced.