Barriers to accessing HIV/AIDS care in North Carolina: Rural and urban differences
Barriers to accessing HIV/AIDS care in North Carolina: Rural and urban differences
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DOI：
10.1080/09540120412331319750
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发表时间：
2005-07-01
影响因子：
1.7
通讯作者：
Smith, SR
中科院分区：
文献类型：
--
作者：
Reif, S;Golin, CE;Smith, SR
许多艾滋病毒阳性者在护理方面面临多重障碍，因此经常遇到得不到满足的医疗和支助服务需求。农村地区往往缺乏支持提供全面艾滋病毒服务的基础设施；然而，很少有研究探讨农村艾滋病毒/艾滋病患者所面临的服务障碍，特别是在南方，那里三分之二的艾滋病毒/艾滋病患者居住在农村地区。我们对受雇于州认证机构的北卡罗来纳州艾滋病毒/艾滋病病例管理人员(N=111)进行了调查，了解影响其城乡客户服药依从性的医疗和支持服务障碍。对于评估的七个障碍(长途旅行、与艾滋病毒相关的耻辱和缺乏交通工具；受过艾滋病毒培训的医生、住房、心理健康服务和药物滥用治疗)中的每一个，相当大比例的病例管理人员(29%-67%)报告说这是一个“主要问题”。在七个障碍中的五个中，农村病例管理人员明显更有可能将障碍视为“主要问题”。多因素分析显示，农村案件管理人员和女性客户较多的案件管理人员报告的障碍较多。由于得不到满足的医疗和支助服务需求可能会导致艾滋病毒阳性者的结果更差，因此必须查明和解决这些服务的障碍，特别是在服务严重不足的农村地区。
Many HIV-positive individuals face multiple barriers to care and therefore frequently experience unmet medical and support services needs. Rural areas often lack the infrastructure to support the delivery of comprehensive HIV services; however, few studies have examined service barriers faced by rural residents with HIV/AIDS, particularly in the South where two-thirds of people living with HIV/AIDS in rural areas reside. We surveyed North Carolina HIV/AIDS case managers (N=111) employed at state-certified agencies regarding barriers to medical and support services that influence medication adherence for their rural and urban-living clients. For each of the seven barriers assessed (long travel for care, HIV-related stigma, and a lack of transportation; HIV-trained medical practitioners; housing; mental health services and substance abuse treatment), a substantial proportion of case managers (29-67%) reported it was a 'major problem'. For five of the seven barriers, rural case managers were significantly more likely to identify the barrier as a 'major problem'. Multivariate analysis revealed that rural case managers and case managers with more female clients reported a greater number of barriers. Because unmet medical and support service needs may result in poorer outcomes for HIV-positive individuals, barriers to these services must be identified and addressed, particularly in rural areas which may be highly underserved.