Details:

Alternative Title:
J Int AIDS Soc
Personal Author:
Fox, Matthew P ; Mazimba, Arthur ; Seidenberg, Phil ; Crooks, Denise ; Sikateyo, Bornwell ; ... More +
Fox, Matthew P ; Mazimba, Arthur ; Seidenberg, Phil ; Crooks, Denise ; Sikateyo, Bornwell ; Rosen, Sydney Less -
Description:
Background

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.

Methods

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.

Results

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.

Conclusions

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.


Subjects:
[+]
Adolescent Adult Anti-HIV Agents Cost Of Illness Cross-Sectional Studies Female Health Services Accessibility HIV Infections Humans Male Middle Aged Perception Research Rural Population Social Stigma Urban Population Young Adult
Source:
J Int AIDS Soc. 2010; 13:8.
Pubmed ID:
20205930
Pubmed Central ID:
PMC2847987
Document Type:
Journal Article
Funding:
U62PS3622410/PS/NCHHSTP CDC HHS/United States
Place as Subject:
Zambia
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:b3da4f816462e7b290f5f76da0b3e699b245221ff7cfcfa00b4c65338ed6b91a
Download URL:
https://stacks.cdc.gov/view/cdc/22913/cdc_22913_DS1.pdf
File Type:

Supporting Files

• 	1758-2652-13-8.nxml	txt
  	license.txt	txt

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