Chanvilay Thammachak, Yoshida Yoshitoku, Reyer Joshua A, Hamajima Nobuyuki
Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan ; Center for HIV/AIDS and STI (CHAS), Healthcare Department, Ministry of Health, Thaphalanxay village, Sisattanak district, Vientiane capital, Lao PDR.
Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nagoya J Med Sci. 2015 Feb;77(1-2):29-39.
Since 2001, antiretroviral therapy (ART) has been available for people living with HIV (PLHIV) in Lao People's Democratic Republic (PDR). Over 10 years of the ART program many HIV patients were found with advanced-stage AIDS in health care service facilities. This study aimed to examine factors associated with delayed access to ART among PLHIV in the capital of Vientiane. A cross-sectional study was conducted with 283 respondents (131 males and 152 females) aged 15 years or over. In this study, delayed access to ART was defined by a CD4 cell count of less than 350 cells/mm(3) at the first screening, or those who presented with advanced AIDS-related symptoms. The odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by a logistic model. After adjustment, young people (OR=2.17; 95% CI: 1.00-4.68; p=0.049), low education (OR=0.23; 95% CI: 0.10-0.55; p=0.001) and duration between risk behavior and HIV test (OR=3.83; 95% CI: 1.22-12.00; p=0.021) were significantly associated with delayed access to ART. Low perception of high risk behaviors was one of the obstacles leading to delayed testing and inability to access ART. Almost all reported feeling self-stigma, and only 30.5% of men and 23.7% of women disclosed the HIV status to his/her partner/spouse. In conclusion, delayed access to ART was associated with individual factors and exposure to health care facility. In order to improve early detection HIV infection following access to ART, an improvement in perceptional knowledge of HIV, as well as reduction of HIV/AIDS-related stigma, might be needed.
自2001年以来，老挝人民民主共和国的艾滋病病毒感染者（PLHIV）可获得抗逆转录病毒疗法（ART）。在ART项目开展的10多年间，许多艾滋病患者在医疗服务机构中被发现处于艾滋病晚期。本研究旨在调查万象市PLHIV中与延迟获得ART相关的因素。对283名年龄在15岁及以上的受访者（131名男性和152名女性）进行了一项横断面研究。在本研究中，延迟获得ART的定义为首次筛查时CD4细胞计数低于350个细胞/mm³，或出现晚期艾滋病相关症状的患者。通过逻辑模型估计比值比（OR）和95%置信区间（CI）。调整后，年轻人（OR=2.17；95%CI：1.00-4.68；p=0.049）、低教育水平（OR=0.23；95%CI：0.10-0.55；p=0.001）以及危险行为与艾滋病毒检测之间的间隔时间（OR=3.83；95%CI：1.22-12.00；p=0.021）与延迟获得ART显著相关。对高风险行为的低认知是导致检测延迟和无法获得ART的障碍之一。几乎所有受访者都表示有自我耻辱感，只有30.5%的男性和23.7%的女性向其伴侣/配偶透露了艾滋病毒感染状况。总之，延迟获得ART与个体因素以及医疗服务机构的接触情况有关。为了在获得ART后改善艾滋病毒感染的早期检测，可能需要提高对艾滋病毒的认知知识，并减少与艾滋病毒/艾滋病相关的耻辱感。
