Plazy M, Newell M-L, Orne-Gliemann J, Naidu K, Dabis F, Dray-Spira R
Centre INSERM U897 for Epidemiology and Biostatistics, Bordeaux, France.
ISPED, University of Bordeaux, France.
HIV Med. 2015 Oct;16(9):521-32. doi: 10.1111/hiv.12253. Epub 2015 Apr 8.
Although antiretroviral therapy (ART) has been freely available since 2004 in South Africa, not all those who are eligible initiate ART. We aimed to investigate individual and household characteristics as barriers to ART initiation in men and women in rural KwaZulu-Natal.
Adults ≥ 16 years old living within a sociodemographic surveillance area (DSA) who accessed the local HIV programme between 2007 and 2011 were included in the study. Individual and household factors associated with ART initiation within 3 months of becoming eligible for ART were investigated using multivariable logistic regression stratified by sex and after exclusion of individuals who died before initiating ART.
Of the 797 men and 1598 women initially included, 8% and 5.5%, respectively, died before ART initiation and were excluded from further analysis. Of the remaining 733 men and 1510 women, 68.2% and 60.2%, respectively, initiated ART ≤ 3 months after becoming eligible (P = 0.34 after adjustment for CD4 cell count). In men, factors associated with a higher ART initiation rate were being a member of a household located < 2 km from the nearest HIV clinic and being resident in the DSA at the time of ART eligibility. In women, ART initiation was more likely in those who were not pregnant, in members of a household where at least one person was on ART and in those with a high wealth index.
In this rural South African setting, barriers to ART initiation differed for men and women. Supportive individual- and household-level interventions should be developed to guarantee rapid ART initiation taking account gender specificities.
尽管自2004年以来抗逆转录病毒疗法（ART）在南非已可免费获得，但并非所有符合条件的人都开始接受ART治疗。我们旨在调查夸祖鲁-纳塔尔省农村地区男性和女性开始接受ART治疗的个体及家庭特征障碍。
纳入2007年至2011年期间在社会人口监测区（DSA）内居住且使用当地艾滋病毒项目的16岁及以上成年人。使用多变量逻辑回归分析按性别分层并排除在开始ART治疗前死亡的个体后，与符合ART治疗条件后3个月内开始接受ART治疗相关的个体和家庭因素。
最初纳入的797名男性和1598名女性中，分别有8%和5.5%在开始ART治疗前死亡并被排除在进一步分析之外。在其余的733名男性和1510名女性中，分别有68.2%和60.2%在符合条件后≤3个月开始接受ART治疗（调整CD4细胞计数后P = 0.34）。在男性中，与较高ART治疗启动率相关的因素包括居住在距离最近的艾滋病毒诊所不到2公里的家庭中，以及在符合ART治疗条件时居住在DSA内。在女性中，未怀孕的女性、家庭中至少有一人正在接受ART治疗的成员以及财富指数较高的女性更有可能开始接受ART治疗。
在南非这个农村地区，男性和女性开始接受ART治疗的障碍有所不同。应制定支持性的个体和家庭层面干预措施，以确保考虑到性别特异性后能迅速开始接受ART治疗。
