Endalamaw Aklilu, Gilks Charles F, Ambaw Fentie, Habtewold Tesfa Dejenie, Assefa Yibeltal
School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia.
College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar P.O. Box 79, Ethiopia.
Infect Dis Rep. 2022 Dec 21;15(1):1-15. doi: 10.3390/idr15010001.
Universal health coverage is essential for the progress to end threats of the acquired immunodeficiency syndrome epidemic. The current review assesses the publication rate, strategies and barriers for antiretroviral therapy (ART) coverage, equity, quality of care, and financial protection. We searched Web of Science, PubMed, and Google Scholar. Of the available articles, 43.13% were on ART coverage, 40.28% were on financial protection, 10.43% were on quality of care, and 6.16% were on equity. A lack of ART, fear of unwanted disclosure, lack of transportation, unaffordable health care costs, long waiting time to receive care, and poverty were barriers to ART coverage. Catastrophic health care costs were higher among individuals who were living in rural settings, walked greater distances to reach health care institutions, had a lower socioeconomic status, and were immunocompromised. There were challenges to the provision of quality of care, including health care providers' inadequate salary, high workload and inadequate health workforce, inappropriate infrastructure, lack of training opportunities, unclear division of responsibility, and the presence of strict auditing. In conclusion, ART coverage was below the global average, and key populations were disproportionally less covered with ART in most countries. Huge catastrophic health expenditures were observed. UHC contexts of ART will be improved by reaching people with poor socioeconomic status, delivering appropriate services, establishing a proper health workforce and service stewardship.
全民健康覆盖对于终结获得性免疫缺陷综合征流行威胁的进展至关重要。本综述评估了抗逆转录病毒疗法(ART)覆盖、公平性、医疗质量和财务保护方面的发表率、策略及障碍。我们检索了科学网、PubMed和谷歌学术。在可得文章中,43.13% 是关于ART覆盖,40.28% 是关于财务保护,10.43% 是关于医疗质量,6.16% 是关于公平性。缺乏ART、担心被不必要地披露、缺乏交通、医疗费用负担不起、接受治疗的等待时间长以及贫困是ART覆盖的障碍。灾难性医疗费用在居住在农村地区、前往医疗机构路程更远、社会经济地位较低且免疫功能低下的个体中更高。提供医疗质量存在挑战,包括医护人员工资不足、工作量大且卫生人力不足、基础设施不当、缺乏培训机会、责任划分不明确以及存在严格审计。总之,ART覆盖低于全球平均水平,在大多数国家关键人群接受ART的覆盖比例不成比例地更低。观察到巨额灾难性医疗支出。通过覆盖社会经济地位差的人群、提供适当服务、建立合适的卫生人力和服务管理,ART的全民健康覆盖情况将得到改善。
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