Kim Hana, Musuka Godfrey N, Mukandavire Zindoga, Branscum Adam, Cuadros Diego F
Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, Ohio, United States of America.
Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, Ohio, United States of America.
PLOS Glob Public Health. 2021 Nov 24;1(11):e0000013. doi: 10.1371/journal.pgph.0000013. eCollection 2021.
Despite efforts to increase the proportion of individuals diagnosed with HIV who receive anti-retroviral therapy, 28% of people living with HIV (PLHIV) aged 15 years and older in eastern and southern Africa and 42% in western and central Africa were not receiving anti-retroviral therapy in 2019. Therefore, improving access to health care services is key to reduce HIV incidence and prevalence. The main aim of this study was to generate high-resolution maps of underserved areas where people cannot access the closest health care facilities within appropriate travel time in sub-Saharan Africa (SSA). Main sources of data for this study were the estimated number of PLHIV for adults aged 15-49 years in 47 countries in SSA and the global map of travel time to the nearest health care facility by motorized and non-motorized transportation. These data were used to estimate and map the number of PLHIV in underserved areas at a travel distance of 10, 30, and 60 minutes from the nearest healthcare facility. We identified and mapped more than 7 million PLHIV in the areas with a lack of access to health care within 10-minute travel time and 1.5 million PLHIV in the areas with a lack of access to health care within 60-minute travel time. The identified locations of underserved areas are an indicator of the challenge faced by PLHIV in accessing health services in SSA, a situation that is likely worsened by the COVID-19 pandemic. These findings can contribute to developing cost-effective geospatial policies for interventions aimed at underserved areas at a finer resolution for communities that have usually been identified in aggregated spatial areas. Further development and implementation of tailored intervention and treatment programs, especially in areas identified as underserved for PLHIV, should be explored. Geospatial analyses could complement the decision-making process with stakeholders to enhance healthcare access for PLHIV in SSA.
尽管人们努力提高接受抗逆转录病毒治疗的艾滋病毒感染者比例，但2019年，东非和南部非洲15岁及以上的艾滋病毒感染者中有28%、西非和中非有42%未接受抗逆转录病毒治疗。因此，改善医疗服务的可及性是降低艾滋病毒发病率和流行率的关键。本研究的主要目的是绘制高分辨率地图，显示撒哈拉以南非洲（SSA）那些在适当的出行时间内无法前往最近医疗设施的服务不足地区。本研究的主要数据来源是SSA 47个国家15至49岁成年人中艾滋病毒感染者的估计人数，以及通过机动和非机动交通方式前往最近医疗设施的出行时间全球地图。这些数据用于估计和绘制距离最近医疗设施10分钟、30分钟和60分钟出行距离内服务不足地区的艾滋病毒感染者人数。我们在10分钟出行时间内无法获得医疗服务的地区识别并绘制了超过700万艾滋病毒感染者，在60分钟出行时间内无法获得医疗服务的地区识别并绘制了150万艾滋病毒感染者。所确定的服务不足地区位置表明了SSA艾滋病毒感染者在获得医疗服务方面面临的挑战，这种情况可能因2019冠状病毒病疫情而恶化。这些发现有助于制定具有成本效益的地理空间政策，以针对那些通常在汇总空间区域中确定的社区，以更高分辨率为服务不足地区实施干预措施。应探索进一步制定和实施量身定制的干预和治疗方案，特别是在被确定为艾滋病毒感染者服务不足的地区。地理空间分析可以辅助与利益相关者的决策过程，以改善SSA艾滋病毒感染者获得医疗服务的情况。
