Haacker Markus, Birungi Charles
a Harvard TH Chan School of Public Health , Boston , USA.
c University College London , London , UK.
Afr J AIDS Res. 2018 Jul;17(2):145-152. doi: 10.2989/16085906.2018.1475401.
Understanding barriers to access to essential health services is critical for devising effective strategies to improve access and align such strategies with national health and development policy objectives. However, while considerable empirical evidence exists on correlates of HIV prevalence and populations at risk of contracting HIV, there is very little such evidence on access to antiretroviral therapy. This paper addresses this gap through a cross-sectional analysis of coverage of antiretroviral therapy and its correlates across 47 counties in Kenya. It considers health-sector and social factors, and applying instrumental variables to address error-in-variables and reverse-causality issues regarding HIV prevalence. Poverty was the most robust and - statistically and substantially - significant determinant of treatment coverage. The gap in treatment coverage between the poorest and richest counties amounted to about 40 percentage points and has not narrowed between 2012 and 2015. Health sector capacities independently played a role and exacerbated the poverty gap. For Kenya, the results suggest that policies on expanding treatment access need to be differentiated across counties to greatest effect and to align the HIV/AIDS response with national health and social policy objectives. Regarding global HIV/AIDS policies, the findings suggest a need to recognise "people left behind" owing to socio-economic and specifically poverty-related barriers to access to services.
了解获取基本卫生服务的障碍对于制定有效的改善获取策略以及使这些策略与国家卫生和发展政策目标保持一致至关重要。然而，虽然存在大量关于艾滋病毒流行率的相关因素以及感染艾滋病毒风险人群的实证证据，但关于获得抗逆转录病毒疗法的此类证据却很少。本文通过对肯尼亚47个县的抗逆转录病毒疗法覆盖情况及其相关因素进行横断面分析，填补了这一空白。它考虑了卫生部门和社会因素，并应用工具变量来解决与艾滋病毒流行率相关的变量误差和反向因果关系问题。贫困是治疗覆盖率最有力且在统计上和实质上都具有显著意义的决定因素。最贫困县和最富裕县之间的治疗覆盖率差距约为40个百分点，且在2012年至2015年期间并未缩小。卫生部门的能力独立发挥了作用，并加剧了贫困差距。对于肯尼亚而言，研究结果表明，扩大治疗可及性的政策需要在各县之间有所区分，以达到最大效果，并使艾滋病毒/艾滋病应对措施与国家卫生和社会政策目标保持一致。关于全球艾滋病毒/艾滋病政策，研究结果表明需要认识到由于社会经济尤其是与贫困相关的服务获取障碍而“被落下的人群”。
