Health insurance financing and patient retention in care at diabetics and hypertension clinics in Dar es Salaam and Pwani regions, Tanzania. A cohort study

Harrieth Manisha; Candida Moshiro; Ally Hussein; Fredrick Amani; Johnson Mshiu; Jaffar Shabbar; Sayoki Mfinanga

doi:10.1371/journal.pgph.0002972

Health insurance financing and patient retention in care at diabetics and hypertension clinics in Dar es Salaam and Pwani regions, Tanzania. A cohort study

PLOS Glob Public Health. 2024 Mar 7;4(3):e0002972. doi: 10.1371/journal.pgph.0002972. eCollection 2024.

Authors

Harrieth Manisha^{1

2}, Candida Moshiro³, Ally Hussein^{2

3}, Fredrick Amani¹, Johnson Mshiu¹, Jaffar Shabbar⁴, Sayoki Mfinanga^{1

2

3

4}

Affiliations

¹ National Institute for Medical Research, Dar es Salaam, Tanzania.
² Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania.
³ Department of Epidemiology and Biostatistics, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
⁴ UCL Institute for Global Health, London, United Kingdom.

Abstract

Hypertension and diabetes are chronic conditions that cause major morbidity and mortality worldwide. Whether health insurance financing is associated with improved retention in chronic care in Tanzania, is unknown. Our study establishes the effect of health insurance on retention and the determinants for retention in care among patients attending diabetes and hypertension clinics. We used a Cohort design to study participants enrolled in a cluster-randomized trial of integrated management of HIV, diabetes, and hypertension compared with standard vertical care in the INTE-AFRICA trial. Fifteen health facilities in Dar es Salam and Pwani regions were enrolled, with 1716 participants. Our sample size had 95% power to detect a 50% to 60% retention difference between the insured and uninsured groups (95% CI). We compared proportions using χ2 tests and obtained prevalence and rate ratios by Generalised Linear Models. We studied 1716 participants for 1612.3 Person-years (PY). At the study's end, 1351 persons were alive and retained in care. Among the insured participants (26.0%), females accounted for 65.9%. Middle-aged adults contributed 58.8% of insured participants. We observed high retention rates (retention incidence rate IR: 83.80/100 PY; 95% CI (79.40-88.40)). There was no difference in retention among insured and uninsured patients (adjusted rate ratio aRR: 1.00; 95% CI, 0.94-1.06). Being middle-aged or senior-aged adults compared to young adults, having diabetes alone or hypertension alone compared to both conditions, having the comorbidity of diabetes or hypertension with HIV compared to a single condition, and attending health centres and hospitals compared to dispensaries were significantly associated with retention in care. This study showed no effect of health insurance on retention in diabetic and hypertension care clinics. However, age, medical diagnosis, morbidity, and type of health facility attended were associated with retention in care.

Copyright: © 2024 Manisha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

Our study was conducted in Tanzania through the Tanzania Field Epidemiology and Laboratory Training Program (TFELTP). TFELTP received support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centre of Excellence in Health Monitoring and Evaluation, Mzumbe University under the U.S Centers for Disease Control and Prevention (CDC), Project Cooperative Agreement No: NU2GGH002292. H.M. Additionally, NIMR, Muhimbili Centre provided further funding and resources for the research through the INTE-Africa project. The INTE-AFRICA project is funded by the European Union’s Horizon 2020 research and innovation program under grant agreement No 825698 as part of the GACD Scale-Up Research Programme. H.M. The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.