Disability Grant: a precarious lifeline for HIV/AIDS patients in South Africa
Disability Grant: a precarious lifeline for HIV/AIDS patients in South Africa
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DOI：
10.1186/s12913-015-0870-8
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发表时间：
2015-06-09
影响因子：
2.8
通讯作者：
Cleary, Susan
中科院分区：
文献类型：
--
作者：
Govender, Veloshnee;Fried, Jana;Cleary, Susan
背景：在南非，艾滋病毒/艾滋病仍然是一个主要的公共卫生问题。在长期失业和贫困加剧的情况下，通过残疾补助金向因精神或身体残疾而无法工作的艾滋病毒/艾滋病成年人提供社会援助。使用混合方法的方法，我们认为1）不平等的访问DG的ART患者和2）影响DG访问正在进行的访问healthcare.Methods：数据收集在出口访谈与1200 ART患者在两个农村和两个城市的卫生分区在四个不同的南非省份。此外，17和18个深入访谈完成了与患者的ART治疗和ART供应商，分别在三个四个网站包括在quantitative phase.Results：赠款受助人是相对较差的比非受助人在就业（9.1%对29.9%）和财富（58.3%，在最贫穷的一半对45.8%）。在控制了社会经济和人口统计学因素、地点、治疗持续时间、依从性和伴随的结核病治疗后，回归分析显示，就业者接受DG的可能性明显低于失业者（p < 0.001）。此外，治疗时间较长并接受伴随治疗的患者（即，抗逆转录病毒治疗和结核病治疗）更有可能接受DG（在5%的水平显着）。定性分析表明，DG减轻了ART患者的医疗保健相关费用的负担。患者和医疗保健提供者都谈到赠款过程和资格标准的复杂性是获得赠款的障碍。这对patient-provider relationships.Conclusions产生了不利影响：这些研究结果突出了DG对艾滋病毒/艾滋病感染者的适当性。然而，改善社会发展部和卫生部之间的合作对于帮助处于社会保障和潜在受益人之间的保健提供者做好准备至关重要。
Background: In South Africa, HIV/AIDS remains a major public health problem. In a context of chronic unemployment and deepening poverty, social assistance through a Disability Grant (DG) is extended to adults with HIV/AIDS who are unable to work because of a mental or physical disability. Using a mixed methods approach, we consider 1) inequalities in access to the DG for patients on ART and 2) implications of DG access for on-going access to healthcare.Methods: Data were collected in exit interviews with 1200 ART patients in two rural and two urban health sub-districts in four different South African provinces. Additionally, 17 and 18 in-depth interviews were completed with patients on ART treatment and ART providers, respectively, in three of the four sites included in the quantitative phase.Results: Grant recipients were comparatively worse off than non-recipients in terms of employment (9.1 % vs. 29.9 %) and wealth (58.3 % in the poorest half vs. 45.8 %). After controlling for socioeconomic and demographic factors, site, treatment duration, adherence and concomitant TB treatment, the regression analyses showed that the employed were significantly less likely to receive the DG than the unemployed (p < 0.001). Also, patients who were longer on treatment and receiving concomitant treatment (i.e., ART and tuberculosis care) were more likely to receive the DG (significant at the 5 % level). The qualitative analyses indicated that the DG alleviated the burden of healthcare related costs for ART patients. Both patients and healthcare providers spoke of the complexity of the grants process and eligibility criteria as a barrier to accessing the grant. This impacted adversely on patient-provider relationships.Conclusions: These findings highlight the appropriateness of the DG for people living with HIV/AIDS. However, improved collaboration between the Departments of Social Development and Health is essential for preparing healthcare providers who are at the interface between social security and potential recipients.