BACKGROUND: Indonesia's National Health Insurance program introduced in 2014 and the National HIV Program of the Ministry of Health (MoH), provides comprehensive coverage for HIV services. However, due to a lack of coordination, there were still out-of-pocket (OOP) payments by people living with HIV (PLHIV) who accessed ARV treatments. The reported OOP includes payments for diagnostic tests, drugs, and administrative fees. To understand better and to develop policy options for achieving Triple 95 by 2020, we conducted an analysis of factors associated with OOP payments among JKN members based on our survey in 2022.
METHODS: We conducted a survey of JKN members who had utilized HIV services in 16 municipalities in Indonesia. A total of 561 PLHIV participated in the survey from April-August 2022. We applied multivariate logistic regression to determine the factors associated with OOP payments in accessing ARV treatment.
RESULTS: Descriptive statistics indicated that 45% of respondents reported paying OOP when they accessed healthcare providers to get ARV treatment. PLHIV who accessed ARV outside of their residence were almost three times more likely to pay OOP than their counterparts who accessed ARV in the same location of their residence (OR=2.8; 95% CI= 1.8-4.6). Furthermore, those who reported travelling more than 30 minutes to the healthcare providers were more likely to pay OOP compared to those who said otherwise (OR=1.6; 95% CI = 1.2-2.3). Meanwhile, those who experienced internalized stigma were twice more likely to pay OOP than those who reported otherwise (OR=1.9; 95% CI = 1.3-2.8). Finally, those who visited hospitals were 1.4 more likely to pay OOP than those who visited primary health care (PHC) providers (OR=1.4; 95% CI = 1.0-2.1).
CONCLUSIONS: We found that almost half of the PLHIV surveyed had OOP payments when visiting healthcare providers. Several factors associated with OOP payments are the location of healthcare providers, internalized stigma (self-stigma), and the type of health healthcare providers (p-value < 0.05). These findings should be communicated effectively to policymakers in ensuring the triple 95 targets of HIV intervention in Indonesia.

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