Research Centre of the University of Montreal Hospital Centre (CRCHUM), 3875 rue Saint-Urbain, Montréal, Québec, H2W 1V1, Canada.
Int J Equity Health. 2012 Mar 6;11:11. doi: 10.1186/1475-9276-11-11.
Until 2010, Burkina Faso was an exception to the international trend of abolishing user fees for antiretroviral treatment (ART). Patients were still expected to pay 1,500F CFA (2 Euros) per month for ART. Nevertheless, many non-governmental organizations (NGOs) exempted patients from payment. The objective of this study was to investigate how NGOs selected the beneficiaries of payment exemptions for government-provided ART and rationed out complementary medical and psychosocial services. For this qualitative study, we conducted 13 individual interviews and three focus group discussions (n = 13 persons) with program staff in nine NGOs (4,000 patients), two NGO coordinating structures and one national program. These encounters were recorded and transcribed, and their content was thematically analyzed. The results were presented to the NGOs for feedback. Results indicate that there are no concrete guidelines for identifying patients warranting payment exemptions. Formerly, ART was scarce in Burkina Faso and the primary criterion for treatment selection was clinical. Our results suggest that this scarcity, mediated by an approach we call sociotherapeutic rationality (i.e. maximization of clinical success), may have led to inequities in the provision of free ART. This approach may be detrimental to assuring equity since the most impoverished lack resources to pay for services that maximize clinical success (e.g. viral load) that would increase their chances of being selected for treatment. However, once selected into treatment, attempts were made to ration-out complementary services more equitably.This study demonstrates the risks entailed by medication scarcity, which presents NGOs and health professionals with impossible choices that run counter to the philosophy of equity in access to treatment. Amid growing concerns of an international funding retreat for ART, it is important to learn from the past in order to better manage the potentially inequitable consequences of ART scarcity.
直到 2010 年，布基纳法索是国际上取消抗逆转录病毒治疗（ART）用户费用这一趋势的例外。患者仍然需要每月支付 1500 非洲法郎（2 欧元）用于 ART。然而，许多非政府组织（NGO）免除了患者的付费。本研究的目的是调查 NGO 如何选择政府提供的 ART 付费豁免的受益人和配给补充医疗和心理社会服务。在这项定性研究中，我们对九家 NGO（4000 名患者）、两家 NGO 协调机构和一个国家方案的工作人员进行了 13 次个人访谈和三次焦点小组讨论（n=13 人）。这些会议被记录下来并转录，然后对其内容进行了主题分析。结果提交给 NGO 征求反馈意见。结果表明，没有具体的指导方针来确定需要支付豁免的患者。以前，ART 在布基纳法索非常稀缺，治疗选择的主要标准是临床标准。我们的结果表明，这种稀缺性，通过我们称之为社会治疗合理性（即最大限度地提高临床成功率）的方法，可能导致免费 ART 提供的不公平。这种方法可能不利于确保公平，因为最贫困的人缺乏资源来支付最能提高临床成功率（例如病毒载量）的服务费用，而这将增加他们被选中接受治疗的机会。然而，一旦被选中接受治疗，就会试图更公平地配给补充服务。这项研究表明，药物稀缺带来的风险，这给 NGO 和卫生专业人员带来了不可能的选择，违背了获得治疗的公平性原则。在人们对国际 ART 资金撤退的担忧日益增加的情况下，从过去吸取教训以更好地管理 ART 稀缺可能带来的潜在不公平后果非常重要。
