Barriers to initiation of antiretroviral treatment in rural and urban areas of Zambia: a cross-sectional study of cost, stigma, and perceptions about ART.
Barriers to initiation of antiretroviral treatment in rural and urban areas of Zambia: a cross-sectional study of cost, stigma, and perceptions about ART.
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DOI：
10.1186/1758-2652-13-8
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发表时间：
2010-03-06
影响因子：
6
通讯作者：
Rosen S
中科院分区：
文献类型：
--
作者：
Fox MP;Mazimba A;Seidenberg P;Crooks D;Sikateyo B;Rosen S
虽然在资源有限的情况下接受抗逆转录病毒疗法(ART)的艾滋病毒阳性患者的数量大幅增加，但一些有资格接受治疗的患者即使在可以获得抗逆转录病毒疗法(ART)的情况下也不会开始接受ART。了解患者为什么选择不参加或不能选择参加，对于实现普遍获得治疗的目标非常重要。我们在赞比亚的两个农村和两个城市的两个地点对400名接受抗逆转录病毒治疗的患者(那些能够获得护理的患者)和400名接受基于家庭的护理(HBC)的患者进行了横断面调查，以确定阻碍和促进抗逆转录病毒治疗的障碍和促进者。HBC患者报告很难去ART诊所就诊的可能性比ART患者高50%(RR：1.48；95%CI：1.21-1.82)。污名在所有地区都很常见，54%的HBC患者害怕去诊所，但只有15%的ART患者害怕去诊所(RR：3.61；95%CI：3.12-4.18)。成本障碍因地点不同而不同：城市HBC患者报告需要付费前往诊所的可能性是ART患者的三倍(RR：2.84；95%CI：2.02-3.98)，认为他们需要在诊所付费的可能性高10倍(RR：9.50；95%CI：2.24-40.3)。在农村地区，HBC受试者比ART受试者报告需要支付非交通费去诊所的可能性更大(RR：4.52；95%CI：1.91-10.7)。无论地点和性别，HBC患者报告没有足够的食物来服用ART的可能性是ART患者的两倍(27%对13%，RR：2.03；95%CI：1.71-2.41)。从未开始抗逆转录病毒治疗的家庭治疗艾滋病毒/艾滋病的患者感觉到寻求艾滋病毒治疗的更大的经济和后勤障碍，并对治疗的好处有更多的负面看法。今后扩大获得抗逆转录病毒治疗的机会的努力应考虑如何减少这些障碍，以鼓励更多符合抗逆转录病毒药物医疗条件的人开始接受治疗。
While the number of HIV-positive patients on antiretroviral therapy (ART) in resource-limited settings has increased dramatically, some patients eligible for treatment do not initiate ART even when it is available to them. Understanding why patients opt out of care, or are unable to opt in, is important to achieving the goal of universal access. We conducted a cross-sectional survey among 400 patients on ART (those who were able to access care) and 400 patients accessing home-based care (HBC), but who had not initiated ART (either they were not able to, or chose not to, access care) in two rural and two urban sites in Zambia to identify barriers to and facilitators of ART uptake. HBC patients were 50% more likely to report that it would be very difficult to get to the ART clinic than those on ART (RR: 1.48; 95% CI: 1.21-1.82). Stigma was common in all areas, with 54% of HBC patients, but only 15% of ART patients, being afraid to go to the clinic (RR: 3.61; 95% CI: 3.12-4.18). Cost barriers differed by location: urban HBC patients were three times more likely to report needing to pay to travel to the clinic than those on ART (RR: 2.84; 95% CI: 2.02-3.98) and 10 times more likely to believe they would need to pay a fee at the clinic (RR: 9.50; 95% CI: 2.24-40.3). In rural areas, HBC subjects were more likely to report needing to pay non-transport costs to attend the clinic than those on ART (RR: 4.52; 95% CI: 1.91-10.7). HBC patients were twice as likely as ART patients to report not having enough food to take ART being a concern (27% vs. 13%, RR: 2.03; 95% CI: 1.71-2.41), regardless of location and gender. Patients in home-based care for HIV/AIDS who never initiated ART perceived greater financial and logistical barriers to seeking HIV care and had more negative perceptions about the benefits of the treatment. Future efforts to expand access to antiretroviral care should consider ways to reduce these barriers in order to encourage more of those medically eligible for antiretrovirals to initiate care.
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影响因子：
15.8
作者：
Mills EJ;Nachega JB;Bangsberg DR;Singh S;Rachlis B;Wu P;Wilson K;Buchan I;Gill CJ;Cooper C
通讯作者：
Cooper C
DOI：
10.1080/09540120701244943
发表时间：
2007-01-01
影响因子：
1.7
作者：
Hardon, A. P.;Akurut, D.;Laing, R.
通讯作者：
Laing, R.
DOI：
10.1080/09540120600839280
发表时间：
2006-01-01
影响因子：
1.7
作者：
Krawczyk, Christopher S.;Funkhouser, Ellen;Vermund, Sten H.
通讯作者：
Vermund, Sten H.
影响因子：
3.7
作者：
Makombe, Simon D.;Jahn, Andreas;Harries, Anthony D.
通讯作者：
Harries, Anthony D.
影响因子：
1.4
作者：
Gold, RS;Hinchy, J;Batrouney, CG
通讯作者：
Batrouney, CG