Department of Infectious Diseases, The Third People's Hospital of Kunming City, Kunming, Yunnan, People's Republic of China.
Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
PLoS One. 2021 May 11;16(5):e0251252. doi: 10.1371/journal.pone.0251252. eCollection 2021.
In the context of scaling up free antiretroviral therapy (ART), healthcare equality is essential for people living with HIV. We aimed to assess socioeconomic-related inequalities in uptake of continuous care for people living with HIV receiving ART, including retention in care in the last six months, routine toxicity monitoring, adequate immunological and virological monitoring, and uptake of mental health assessment in the last 12 months. We also determined the contributions of socioeconomic factors to the degree of inequalities.
A hospital-based cross-sectional survey was conducted among consecutive clients visiting an HIV treatment center in Kunming, China in 2019. Participants were 702 people living with HIV aged ≥18 years (median age: 41.0 years, 69.4% male) who had been on ART for 1-5 years. Socioeconomic-related inequality and its contributing factors were assessed by a normalized concentration index (CIn) with a decomposition approach.
The uptake of mental health assessment was low (15%) but significantly higher among the rich (CIn 0.1337, 95% CI: 0.0140, 0.2534). Retention in care, toxicity, and immunological monitoring were over 80% but non-significant in favor of the rich (CIn: 0.0117, 0.0315, 0.0736, respectively). The uptake of adequate virological monitoring was 15% and higher among the poor (CIn = -0.0308). Socioeconomic status positively contributed to inequalities of all care indicators, with the highest contribution for mental health assessment (124.9%) and lowest for virological monitoring (2.7%).
These findings suggest virological monitoring and mental health assessment be given more attention in long-term HIV care. Policies allocating need-oriented resources geared toward improving equality of continuous care should be developed.
在扩大免费抗逆转录病毒疗法（ART）的规模时，医疗保健公平对于艾滋病毒感染者至关重要。我们旨在评估接受 ART 治疗的艾滋病毒感染者连续护理的获取情况中的社会经济相关不平等现象，包括过去六个月的护理保留率、常规毒性监测、充分的免疫和病毒学监测以及过去 12 个月的心理健康评估。我们还确定了社会经济因素对不平等程度的贡献。
2019 年，在中国昆明的一家艾滋病治疗中心进行了一项基于医院的横断面调查。研究对象为 702 名年龄≥18 岁（中位年龄：41.0 岁，69.4%为男性）、接受 ART 治疗 1-5 年的艾滋病毒感染者。采用标准化集中指数（CIn）和分解方法评估与社会经济相关的不平等及其影响因素。
心理健康评估的接受率较低（15%），但富人的接受率明显更高（CIn 0.1337，95%CI：0.0140，0.2534）。保留在护理中、毒性和免疫监测的比例均超过 80%，但对富人无显著倾斜（CIn：0.0117，0.0315，0.0736）。适当的病毒学监测率为 15%，且穷人的接受率更高（CIn = -0.0308）。社会经济地位对所有护理指标的不平等均有积极贡献，对心理健康评估的贡献最大（124.9%），对病毒学监测的贡献最小（2.7%）。
这些发现表明，应更加关注病毒学监测和心理健康评估，在长期的 HIV 护理中。应制定有针对性地分配资源的政策，以改善连续护理的公平性。
