People living with HIV travel farther to access healthcare: a population-based geographic analysis from rural Uganda
Identifieur interne : 000E90 ( Main/Exploration ); précédent : 000E89; suivant : 000E91People living with HIV travel farther to access healthcare: a population-based geographic analysis from rural Uganda
Auteurs : Adam N. Akullian [États-Unis] ; Aggrey Mukose [Ouganda] ; Gillian A. Levine [États-Unis] ; Joseph B. Babigumira [États-Unis]Source :
- Journal of the International AIDS Society [ 1758-2652 ] ; 2016.
Abstract
The availability of specialized HIV services is limited in rural areas of sub-Saharan Africa where the need is the greatest. Where HIV services are available, people living with HIV (PLHIV) must overcome large geographic, economic and social barriers to access healthcare. The objective of this study was to understand the unique barriers PLHIV face when accessing healthcare compared with those not living with HIV in a rural area of sub-Saharan Africa with limited availability of healthcare infrastructure.
We conducted a population-based cross-sectional study of 447 heads of household on Bugala Island, Uganda. Multiple linear regression models were used to compare travel time, cost and distance to access healthcare, and log binomial models were used to test for associations between HIV status and access to nearby health services.
PLHIV travelled an additional 1.9 km (95% CI (0.6, 3.2 km),
PLHIV travel longer distances for care, a phenomenon that may be driven by both the limited availability of specialized HIV services and preference for higher tiered facilities.
Url:
DOI: 10.7448/IAS.19.1.20171
PubMed: 26869359
PubMed Central: 4751409
Affiliations:
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Akullian</name><affiliation wicri:level="2"><nlm:aff id="AF0001">Institute for Disease Modeling, Bellevue, WA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Institute for Disease Modeling, Bellevue, WA</wicri:regionArea><placeName><region type="state">Washington (État)</region></placeName></affiliation></author><author><name sortKey="Mukose, Aggrey" sort="Mukose, Aggrey" uniqKey="Mukose A" first="Aggrey" last="Mukose">Aggrey Mukose</name><affiliation wicri:level="1"><nlm:aff id="AF0002">Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Levine, Gillian A" sort="Levine, Gillian A" uniqKey="Levine G" first="Gillian A" last="Levine">Gillian A. Levine</name><affiliation wicri:level="4"><nlm:aff id="AF0003">Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation></author><author><name sortKey="Babigumira, Joseph B" sort="Babigumira, Joseph B" uniqKey="Babigumira J" first="Joseph B" last="Babigumira">Joseph B. Babigumira</name><affiliation wicri:level="4"><nlm:aff id="AF0004">Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26869359</idno><idno type="pmc">4751409</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4751409</idno><idno type="RBID">PMC:4751409</idno><idno type="doi">10.7448/IAS.19.1.20171</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000388</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000388</idno><idno type="wicri:Area/Pmc/Curation">000388</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000388</idno><idno type="wicri:Area/Pmc/Checkpoint">000567</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000567</idno><idno type="wicri:Area/Ncbi/Merge">003598</idno><idno type="wicri:Area/Ncbi/Curation">003598</idno><idno type="wicri:Area/Ncbi/Checkpoint">003598</idno><idno type="wicri:Area/Main/Merge">000E90</idno><idno type="wicri:Area/Main/Curation">000E90</idno><idno type="wicri:Area/Main/Exploration">000E90</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">People living with HIV travel farther to access healthcare: a population-based geographic analysis from rural Uganda</title><author><name sortKey="Akullian, Adam N" sort="Akullian, Adam N" uniqKey="Akullian A" first="Adam N" last="Akullian">Adam N. Akullian</name><affiliation wicri:level="2"><nlm:aff id="AF0001">Institute for Disease Modeling, Bellevue, WA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Institute for Disease Modeling, Bellevue, WA</wicri:regionArea><placeName><region type="state">Washington (État)</region></placeName></affiliation></author><author><name sortKey="Mukose, Aggrey" sort="Mukose, Aggrey" uniqKey="Mukose A" first="Aggrey" last="Mukose">Aggrey Mukose</name><affiliation wicri:level="1"><nlm:aff id="AF0002">Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Levine, Gillian A" sort="Levine, Gillian A" uniqKey="Levine G" first="Gillian A" last="Levine">Gillian A. Levine</name><affiliation wicri:level="4"><nlm:aff id="AF0003">Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation></author><author><name sortKey="Babigumira, Joseph B" sort="Babigumira, Joseph B" uniqKey="Babigumira J" first="Joseph B" last="Babigumira">Joseph B. Babigumira</name><affiliation wicri:level="4"><nlm:aff id="AF0004">Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation></author></analytic><series><title level="j">Journal of the International AIDS Society</title><idno type="eISSN">1758-2652</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Introduction</title><p>The availability of specialized HIV services is limited in rural areas of sub-Saharan Africa where the need is the greatest. Where HIV services are available, people living with HIV (PLHIV) must overcome large geographic, economic and social barriers to access healthcare. The objective of this study was to understand the unique barriers PLHIV face when accessing healthcare compared with those not living with HIV in a rural area of sub-Saharan Africa with limited availability of healthcare infrastructure.</p></sec><sec id="st2"><title>Methods</title><p>We conducted a population-based cross-sectional study of 447 heads of household on Bugala Island, Uganda. Multiple linear regression models were used to compare travel time, cost and distance to access healthcare, and log binomial models were used to test for associations between HIV status and access to nearby health services.</p></sec><sec id="st3"><title>Results</title><p>PLHIV travelled an additional 1.9 km (95% CI (0.6, 3.2 km), <italic>p</italic>=0.004) to access healthcare compared with those not living with HIV, and they were 56% less likely to access healthcare at the nearest health facility to their residence, so long as that facility lacked antiretroviral therapy (ART) services (aRR=0.44, 95% CI (0.24 to 0.83), <italic>p</italic>=0.011). We found no evidence that PLHIV travelled further for care if the nearest facility supplies ART services (aRR=0.95, 95% CI (0.86 to 1.05), <italic>p</italic>=0.328). Among those who reported uptake of care at one of two facilities on the island that provides ART (81% of PLHIV and 68% of HIV-negative individuals), PLHIV tended to seek care at a higher tiered facility that provides ART, even when this facility was not their closest facility (30% of PLHIV travelled further than the closest ART facility compared with 16% of HIV-negative individuals), and travelled an additional 2.2 km (<italic>p</italic>=0.001) to access that facility, relative to HIV-negative individuals (aRR=1.91, 95% CI (1.00 to 3.65), <italic>p</italic>=0.05). Among PLHIV, residential distance was associated with access to facilities providing ART (RR=0.78, 95% CI (0.61 to 0.99), <italic>p</italic>=0.044, comparing residential distances of 3–5 km to 0–2 km; RR=0.71, 95% CI (0.58 to 0.87), <italic>p</italic>=0.001, comparing residential distances of 6–10 km to 0–2 km).</p></sec><sec id="st4"><title>Conclusions</title><p>PLHIV travel longer distances for care, a phenomenon that may be driven by both the limited availability of specialized HIV services and preference for higher tiered facilities.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Posse, M" uniqKey="Posse M">M Posse</name></author><author><name sortKey="Meheus, F" uniqKey="Meheus F">F Meheus</name></author><author><name sortKey="Van Asten, H" uniqKey="Van Asten H">H van Asten</name></author><author><name sortKey="Van Der Ven, A" uniqKey="Van Der Ven A">A van der Ven</name></author><author><name 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uniqKey="Cox J">J Cox</name></author><author><name sortKey="Campbell, Om" uniqKey="Campbell O">OM Campbell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kloos, H" uniqKey="Kloos H">H Kloos</name></author><author><name sortKey="Assefa, Y" uniqKey="Assefa Y">Y Assefa</name></author><author><name sortKey="Adugna, A" uniqKey="Adugna A">A Adugna</name></author><author><name sortKey="Mulatu, Ms" uniqKey="Mulatu M">MS Mulatu</name></author><author><name sortKey="Mariam, Dh" uniqKey="Mariam D">DH Mariam</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lazarus, Jv" uniqKey="Lazarus J">JV Lazarus</name></author><author><name sortKey="Safreed Harmon, K" uniqKey="Safreed Harmon K">K Safreed-Harmon</name></author><author><name sortKey="Nicholson, J" uniqKey="Nicholson J">J Nicholson</name></author><author><name sortKey="Jaffar, S" uniqKey="Jaffar S">S Jaffar</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Ouganda</li><li>États-Unis</li></country><region><li>Washington (État)</li></region><settlement><li>Seattle</li></settlement><orgName><li>Université de Washington</li></orgName></list><tree><country name="États-Unis"><region name="Washington (État)"><name sortKey="Akullian, Adam N" sort="Akullian, Adam N" uniqKey="Akullian A" first="Adam N" last="Akullian">Adam N. Akullian</name></region><name sortKey="Babigumira, Joseph B" sort="Babigumira, Joseph B" uniqKey="Babigumira J" first="Joseph B" last="Babigumira">Joseph B. Babigumira</name><name sortKey="Levine, Gillian A" sort="Levine, Gillian A" uniqKey="Levine G" first="Gillian A" last="Levine">Gillian A. Levine</name></country><country name="Ouganda"><noRegion><name sortKey="Mukose, Aggrey" sort="Mukose, Aggrey" uniqKey="Mukose A" first="Aggrey" last="Mukose">Aggrey Mukose</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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