David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
Partners in Hope, Lilongwe, Malawi.
AIDS Behav. 2024 Aug;28(8):2639-2649. doi: 10.1007/s10461-024-04352-9. Epub 2024 Jun 13.
Across sub-Saharan Africa, men are less likely to know their HIV status than women, leading to later treatment initiation. Little is known about how experiences with general health services affect men's use of HIV testing. We used data from a 2019 community-representative survey of men in Malawi to understand frequency and cause of men's negative health service experiences (defined as men reporting they "would not recommend" a facility) and their association with future HIV testing. We conducted univariable and multivariable logistic regressions to determine which aspects of health facility visits were associated with would-not-recommend experiences and to determine if would-not-recommend experiences 12-24 months prior to the survey were associated with HIV testing in the 12 months prior to the survey. Among 1,098 men eligible for HIV testing in the 12 months prior to the survey, median age was 34 years; 9% of men reported at least one would-not-recommend experience, which did not differ by sociodemographics, gender norm beliefs, or HIV stigma beliefs. The factors most strongly associated with would-not-recommend experiences were cost (aOR 5.8, 95%CI 2.9-11.4), cleanliness (aOR 4.2, 95%CI 1.8-9.9), medicine availability (aOR 3.3, 95%CI 1.7-6.4), and wait times (aOR 2.7, 95%CI 1.5-5.0). Reporting a would-not-recommend experience 12-24 months ago was associated with a 59% decrease in likelihood of testing for HIV in the last 12 months (aOR 0.41; 95% CI:0.17-0.96). Dissatisfaction with general health services was strongly associated with reduced HIV testing. Coverage of high-priority screening services like HIV testing may benefit from improving overall health system quality.
在撒哈拉以南非洲地区,男性知晓自己 HIV 感染状况的可能性低于女性,导致他们更晚接受治疗。人们对一般卫生服务的体验如何影响男性对 HIV 检测的使用知之甚少。我们使用了来自马拉维 2019 年社区代表性男性调查的数据,以了解男性负面卫生服务体验(定义为男性报告他们“不会推荐”某个机构)的发生频率和原因,以及这些体验与未来 HIV 检测之间的关联。我们进行了单变量和多变量逻辑回归,以确定卫生机构就诊的哪些方面与“不会推荐”体验有关,并确定在调查前 12-24 个月的“不会推荐”体验是否与调查前 12 个月的 HIV 检测有关。在有资格在调查前 12 个月接受 HIV 检测的 1098 名男性中,中位年龄为 34 岁;9%的男性报告至少有一次“不会推荐”的体验,但这与社会人口统计学、性别规范信念或 HIV 耻辱感信念无关。与“不会推荐”体验最相关的因素是费用(比值比 5.8,95%置信区间 2.9-11.4)、清洁度(比值比 4.2,95%置信区间 1.8-9.9)、药物供应(比值比 3.3,95%置信区间 1.7-6.4)和等待时间(比值比 2.7,95%置信区间 1.5-5.0)。报告在 12-24 个月前有“不会推荐”的体验,与过去 12 个月内进行 HIV 检测的可能性降低 59%相关(比值比 0.41;95%置信区间:0.17-0.96)。对一般卫生服务的不满与 HIV 检测的减少密切相关。改善高优先级筛查服务(如 HIV 检测)的覆盖率可能受益于提高整体卫生系统质量。
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