Kloos Helmut, Assefa Yibeltal, Adugna Aynalem, Mulatu Mesfin Samuel, Mariam Damen Haile
Department of Epidemiology and Biostatistics, University of California, San Francisco Medical Center, San Francisco, CA, USA.
Int J Health Geogr. 2007 Sep 25;6:45. doi: 10.1186/1476-072X-6-45.
In 2003, the Ethiopian Ministry of Health (MOH) started to implement a national antiretroviral treatment (ART) program. Using data in the monthly HIV/AIDS Updates issued by the MOH, this paper examines the spatial and temporal distribution of ART on a population basis for Ethiopian towns and administrative zones and regions for the period February to December 2006.
The 101 public ART hospitals treated 44,446 patients and the 91 ART health centers treated 1,599 patients in December 2006. The number of patients currently receiving ART doubled between February and December 2006 and the number of female patients aged 15 years and older surpassed male patients, apparently due to increased awareness and provision of free ART. Of 58,405 patients who ever started ART in December 2006, 46,045 (78.8%) were adhering to treatment during that month. Population coverage of ART was highest in the three urban administrative regions of Addis Ababa, Harari and Dire Dawa, in regional centers with referral hospitals, and in several small road side towns that had former mission or other NGO-operated hospitals. Hospitals in Addis Ababa had the largest patient loads (on average 850 patients) and those in SNNPR (Southern Nations and Nationalities Peoples Republic) (212 patients) and Somali (130 patients) regions the fewest patients. In bivariate tests, number of patients receiving treatment was significantly correlated with population size of towns, urban population per zone, number of hospitals per zone, and duration of ART services in 2006 (all p < 0.001). The stronger relationship with urban than total zonal populations (p < 0.001 versus p = 0.014) and the positive correlation between distance from 44 health centers to the nearest ART hospital and patients receiving treatment at these health centers may be due to a combination of differential accessibility of ART sites, patient knowledge and health-seeking behavior.
The sharp increase in ART uptake in 2006 is largely due to the rapid increase in the provision of free treatment at more sites. The marked variation in ART utilization patterns between urban and rural communities and among zones and regions requires further studies. Recommendations are made for further expansion and sustainability of the ART scale-up.
2003年，埃塞俄比亚卫生部开始实施国家抗逆转录病毒治疗（ART）计划。本文利用埃塞俄比亚卫生部发布的月度艾滋病毒/艾滋病最新情况中的数据，对2006年2月至12月期间埃塞俄比亚城镇、行政区和地区基于人群的抗逆转录病毒治疗的时空分布进行了研究。
2006年12月，101家公共抗逆转录病毒治疗医院治疗了44446名患者，91家抗逆转录病毒治疗保健中心治疗了1599名患者。2006年2月至12月期间，目前接受抗逆转录病毒治疗的患者人数翻了一番，15岁及以上女性患者人数超过男性患者，这显然是由于意识提高和免费抗逆转录病毒治疗的提供。在2006年12月开始接受抗逆转录病毒治疗的58405名患者中，有46045名（78.8%）在该月坚持治疗。抗逆转录病毒治疗的人群覆盖率在亚的斯亚贝巴、哈拉里和迪雷达瓦这三个城市行政区、设有转诊医院的地区中心以及一些曾有教会或其他非政府组织运营医院的小型路边城镇最高。亚的斯亚贝巴的医院患者负荷最大（平均850名患者），而南方各族州（SNNPR）（212名患者）和索马里州（130名患者）的医院患者最少。在双变量检验中，接受治疗的患者人数与城镇人口规模、每个区的城市人口、每个区的医院数量以及2006年抗逆转录病毒治疗服务的持续时间显著相关（所有p<0.001）。与城市人口而非全区总人口的关系更强（p<0.001对p = 0.014），以及44家保健中心到最近的抗逆转录病毒治疗医院的距离与在这些保健中心接受治疗的患者之间的正相关，可能是由于抗逆转录病毒治疗地点的可及性差异、患者知识和就医行为等多种因素的综合作用。
2006年抗逆转录病毒治疗的接受率大幅上升主要是由于更多地点免费治疗供应的迅速增加。城乡社区之间以及各区域之间抗逆转录病毒治疗利用模式的显著差异需要进一步研究。针对抗逆转录病毒治疗扩大规模的进一步扩展和可持续性提出了建议。
