Msellati Philippe, Juillet-Amari Anne, Prudhomme Joanne, Akribi Hortense Aka-Dago, Coulibaly-Traore Djénéba, Souville Marc, Moatti Jean-Paul
Institute for Research & Development (LPE/IRD), University of Provence, Marseille, France.
AIDS. 2003 Jul;17 Suppl 3:S63-8. doi: 10.1097/00002030-200317003-00009.
To compare socio-economic and health characteristics of HIV-infected patients in Côte d'Ivoire whether or not they had access to the Drug Access Initiative (DAI) and to antiretroviral drug (ARV) treatment.
Cross-sectional survey using medical files, blood sampling for CD4 cell counts and face-to-face interviews among all patients, informed of their HIV status, who attended during a 6-week period in the five DAI referral centres and three additional centres in charge of HIV care in Abidjan and Bouaké (participation rate = 65.4%). Multiple logistic regression using generalized estimating equations (GEE) to identify factors related to non-access to DAI and to ARV treatment.
Among the 711 respondents, 23.0% were ARV-treated, 14.2% had been included in the DAI but were still waiting for initiation of ARV, and 62.7% were neither part of the DAI nor ARV-treated. In this latter group, less than one-third (29.6%) declared that they knew about the existence of the DAI. Among the 164 ARV-treated patients, 59.1% had benefited from DAI public subsidies partially covering the costs of drugs. In the non-DAI-non-ARV-treated group, 86% could have qualified for ARV treatment according to the DAI medical criteria (CD4 cell counts < 500 x 10(6) cells/l), and only 32.9% of those medically eligible were prescribed cotrimoxazole prophylaxis. In multivariate analysis, not being in the DAI and not being ARV-treated was related to: being a male, not having health care insurance, having a low level of education, living in poor housing conditions (absence of refrigerator in the household, absence of ventilation in patient's bedroom), and not being under cotrimoxazole prophylaxis.
The Ivoirian DAI has facilitated access to ARV treatment for a significant number of patients with limited ability to pay. The majority of HIV-infected patients seeking care however face persisting socio-economic and informational barriers to access to these treatments.
比较科特迪瓦感染艾滋病毒患者的社会经济和健康特征，这些患者是否能够获得药品获取倡议（DAI）及抗逆转录病毒药物（ARV）治疗。
采用横断面调查，利用医疗档案、采集血样进行CD4细胞计数，并对所有知晓自己艾滋病毒感染状况的患者进行面对面访谈。这些患者在为期6周的时间里前往五个DAI转诊中心以及阿比让和布瓦凯另外三个负责艾滋病毒护理的中心就诊（参与率 = 65.4%）。使用广义估计方程（GEE）进行多因素逻辑回归，以确定与无法获得DAI及ARV治疗相关的因素。
在711名受访者中，23.0%接受了ARV治疗，14.2%已被纳入DAI但仍在等待开始ARV治疗，62.7%既未参与DAI也未接受ARV治疗。在后者这组中，不到三分之一（29.6%）宣称知晓DAI的存在。在164名接受ARV治疗的患者中，59.1%受益于DAI公共补贴，该补贴部分覆盖了药品费用。在未参与DAI且未接受ARV治疗的组中，根据DAI医疗标准（CD4细胞计数 < 500×10⁶个细胞/升），86%本可符合ARV治疗条件，而在这些符合医疗条件的患者中，只有32.9%接受了复方新诺明预防治疗。在多变量分析中，未参与DAI且未接受ARV治疗与以下因素相关：男性、没有医疗保险、教育程度低、居住条件差（家中没有冰箱、患者卧室没有通风设备）以及未接受复方新诺明预防治疗。
科特迪瓦的DAI为大量支付能力有限的患者提供了获得ARV治疗的便利。然而，大多数寻求治疗的艾滋病毒感染患者在获取这些治疗方面仍面临持续存在的社会经济和信息障碍。
