Unequal access to ART: exploratory results from rural and urban case studies of ART use
Unequal access to ART: exploratory results from rural and urban case studies of ART use
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DOI：
10.1136/sextrans-2011-050136
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发表时间：
2012-03-01
影响因子：
3.6
通讯作者：
Schneider, Helen
中科院分区：
文献类型：
--
作者：
Cleary, Susan May;Birch, Stephen;Schneider, Helen
1.南非拥有世界上最大的抗逆转录病毒治疗方案。虽然公共部门的服务在使用时是免费的，但人们对总体获取障碍知之甚少。本文探讨了这些障碍的角度来看，ART用户注册的服务，在两个农村和两个城市setting.Methods使用一个全面的框架访问，访谈进行了超过1200 ART用户评估障碍沿着三个方面：可用性，可负担性和可接受性。摘要统计数据进行计算和比较，网站之间的访问障碍进行了探讨，采用多元线性和logistic regressions.Results的可用性，而在农村设置的访问障碍被发现通过一个更分散的模式，在一个网站提供服务，负担能力的障碍是相当高的农村与城市设置。在一个农村地区，50%的受访者发生了灾难性的医疗支出，36%的人借钱支付这些费用。在可接受性方面，农村使用者不太可能报告感到受到卫生工作者的尊重。据报道，污名是最低的两个网站与最分散的服务和最高的覆盖面的那些在need.Conclusions虽然结果表明不公平的获得ART农村相对于城市用户，护士主导的服务提供通过初级医疗保健设施减轻了这些障碍，在一个农村网站。这是一个重要的发现，因为南非目前的政策强调分散和护士主导的ART。这项研究是第一次提出关于准入障碍的全面证据，以协助设计政策解决方案。
Introduction South Africa has the world's largest antiretroviral treatment (ART) programme. While services in the public sector are free at the point of use, little is known about overall access barriers. This paper explores these barriers from the perspective of ART users enrolled in services in two rural and two urban settings.Methods Using a comprehensive framework of access, interviews were conducted with over 1200 ART users to assess barriers along three dimensions: availability, affordability and acceptability. Summary statistics were computed and comparisons of access barriers between sites were explored using multivariate linear and logistic regressions.Results While availability access barriers in rural settings were found to be mitigated through a more decentralised model of service provision in one site, affordability barriers were considerably higher in rural versus urban settings. 50% of respondents incurred catastrophic healthcare expenditure and 36% borrowed money to cover these expenses in one rural site. On acceptability, rural users were less likely to report feeling respected by health workers. Stigma was reported to be lowest in the two sites with the most decentralised services and the highest coverage of those in need.Conclusions While results suggest inequitable access to ART for rural relative to urban users, nurse-led services offered through primary healthcare facilities mitigated these barriers in one rural site. This is an important finding given current policy emphasis on decentralised and nurse-led ART in South Africa. This study is one of the first to present comprehensive evidence on access barriers to assist in the design of policy solutions.