Disease awareness and healthcare utilization in rural South Africa: a comparative analysis of HIV and diabetes in the HAALSI cohort.
Disease awareness and healthcare utilization in rural South Africa: a comparative analysis of HIV and diabetes in the HAALSI cohort.
复制标题
南非农村地区的疾病意识和医疗保健利用：Haalsi队列中艾滋病毒和糖尿病的比较分析。
DOI：
10.1186/s12889-023-17043-2
复制
发表时间：
2023-11-08
影响因子：
4.5
通讯作者：
Rosenberg, Molly
中科院分区：
文献类型：
--
作者：
Beidelman, Erika T.;Baernighausen, Till;Wing, Coady;Tollman, Stephen;Phillips, Meredith L.;Rosenberg, Molly
来自南非农村的研究表明，艾滋病病毒感染者（PLHIV）可能比未感染者拥有更好的健康状况，这可能是由于感染所必需的频繁就医。在此，我们以糖尿病作为另一种高负担、医疗需求大的疾病的示例比较对象，研究了艾滋病病毒感染状况与医疗利用之间的关联。
我们关注的暴露因素是对艾滋病病毒和糖尿病阳性疾病状态的知晓情况。我们确定了742名艾滋病病毒阳性且知晓自身状况的个体，以及305名患有糖尿病且知晓自身状况的个体。艾滋病病毒阳性状况进一步按病毒抑制情况分组。对于每种疾病，我们估计了与以下因素的关联：（1）其他合并的慢性疾病，（2）医疗机构就诊次数，（3）家庭层面的医疗支出，以及（4）每次就诊的医疗支出。我们使用对数二项回归模型来估计合并慢性疾病的患病率比值。线性回归模型用于所有其他结果。
与未感染艾滋病病毒的人相比，病毒得到抑制的艾滋病病毒感染者慢性疾病患病率降低，公立诊所就诊次数增加[β = 0.59，95%置信区间：0.5，0.7]，每次在私立诊所的花费减少[β = -60，95%置信区间：-83，-6]。在病毒得到抑制的艾滋病病毒感染者和非感染者之间，住院情况以及在医院和公立诊所每次就诊的花费没有差异。相反，与未患糖尿病的人相比，糖尿病患者慢性疾病患病率增加，各类医疗机构就诊次数增加，家庭层面支出增加（β = 88兰特，95%置信区间：29，154），每次在医院的花费增加（β = 54兰特，95%置信区间：7，155），每次在公立诊所的花费增加（β = 31兰特，95%置信区间：2，74）。
我们的研究结果表明，成年艾滋病病毒感染者可能比艾滋病病毒阴性的同龄人更频繁地前往公立诊所就诊，但每次就诊的花费相似。这提供了初步证据，表明在南非农村的艾滋病病毒感染者中观察到的积极健康结果可能是由不同的医疗参与模式所解释。通过我们对艾滋病病毒感染者和糖尿病患者的示例比较，我们表明，疾病负担向慢性疾病以及像糖尿病这样历史上资金不足的疾病转移，可能正在改变医疗支出不平等的格局。
网络版包含补充材料，可在10.1186/s12889 - 023 - 17043 - 2获取。
Studies from rural South Africa indicate that people living with HIV (PLHIV) may have better health outcomes than those without, potentially due to the frequent healthcare visits necessitated by infection. Here, we examined the association between HIV status and healthcare utilization, using diabetes as an illustrative comparator of another high-burden, healthcare-intensive disease. Our exposure of interest was awareness of positive disease status for both HIV and diabetes. We identified 742 individuals who were HIV-positive and aware of their status and 305 who had diabetes and were aware of their status. HIV-positive status was further grouped by viral suppression. For each disease, we estimated the association with (1) other comorbid, chronic conditions, (2) health facility visits, (3) household-level healthcare expenditure, and (4) per-visit healthcare expenditure. We used log-binomial regression models to estimate prevalence ratios for co-morbid chronic conditions. Linear regression models were used for all other outcomes. Virally suppressed PLHIV had decreased prevalence of chronic conditions, increased public clinic visits [β = 0.59, 95% CI: 0.5, 0.7], and reduced per-visit private clinic spending [β = -60, 95% CI: -83, -6] compared to those without HIV. No differences were observed in hospitalizations and per-visit spending at hospitals and public clinics between virally suppressed PLHIV and non-PLHIV. Conversely, diabetic individuals had increased prevalence of chronic conditions, increased visits across facility types, increased household-level expenditures (β = 88 R, 95% CI: 29, 154), per-visit hospital spending (β = 54 R, 95% CI: 7, 155), and per-visit public clinic spending (β = 31 R, 95% CI: 2, 74) compared to those without diabetes. Our results suggest that older adult PLHIV may visit public clinics more often than their HIV-negative counterparts but spend similarly on a per-visit basis. This provides preliminary evidence that the positive health outcomes observed among PLHIV in rural South Africa may be explained by different healthcare engagement patterns. Through our illustrative comparison between PLHIV and diabetics, we show that shifting disease burdens towards chronic and historically underfunded diseases, like diabetes, may be changing the landscape of health expenditure inequities. The online version contains supplementary material available at 10.1186/s12889-023-17043-2.
登录
查看更多内容
影响因子：
17.3
作者：
Gibbons, Daniel C.;Bindman, Andrew B.;Majeed, Azeem
通讯作者：
Majeed, Azeem
DOI：
10.1097/qai.0000000000001445
发表时间：
2017-08-15
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Manne-Goehler J;Montana L;Gómez-Olivé FX;Rohr J;Harling G;Wagner RG;Wade A;Kabudula CW;Geldsetzer P;Kahn K;Tollman S;Berkman LF;Bärnighausen TW;Gaziano TA
通讯作者：
Gaziano TA
影响因子：
3.7
作者：
Hontelez JA;Tanser FC;Naidu KK;Pillay D;Bärnighausen T
通讯作者：
Bärnighausen T
影响因子：
7.7
作者：
Kahn K;Collinson MA;Gómez-Olivé FX;Mokoena O;Twine R;Mee P;Afolabi SA;Clark BD;Kabudula CW;Khosa A;Khoza S;Shabangu MG;Silaule B;Tibane JB;Wagner RG;Garenne ML;Clark SJ;Tollman SM
通讯作者：
Tollman SM
DOI：
10.1097/qai.0000000000001014
发表时间：
2016-09-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Marcus JL;Chao CR;Leyden WA;Xu L;Quesenberry CP Jr;Klein DB;Towner WJ;Horberg MA;Silverberg MJ
通讯作者：
Silverberg MJ