Fan Zhixin, Zheng Songlin, Cui Weiming, Zheng Chao, Sun Qiang, Yin Jia
Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.
NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, 250012, China.
BMC Infect Dis. 2025 Feb 1;25(1):155. doi: 10.1186/s12879-025-10567-5.
Antiretroviral drugs are important for HIV/AIDS patients, but we know little about the real-life barriers patients face in accessing them. Following the Levesque framework, this study described the five abilities of HIV/AIDS patients in Shandong Province to perceive, to seek, to reach, to pay and to engage in accessing antiretroviral drugs and the factors associated with them.
A cross-sectional questionnaire survey, using convenience sampling, was conducted among HIV/AIDS patients in three AIDS-designated hospitals in Shandong Province. We used catastrophic cost methods and the HIV Treatment Adherence Self-efficacy Scale to assess patients' ability to pay and engage, respectively.
A total of 301 participants completed the questionnaire, with 20.9% having a CD4 cell count of less than 200 cells/µL. For the ability to perceive, only 16.6% of respondents self-reported low knowledge of HIV progression and medication. For the ability to seek, 24.3% self-reported having experienced social discrimination, and 21.9% reported 'choosing not to seek health insurance reimbursement due to fear of privacy disclosure. For the ability to reach, the average time spent on purchasing drugs was 2.1 ± 1.3 h, with respondents living in rural areas and having low levels of education most likely to spend more hours. For the ability to pay, the overall incidence of catastrophic health expenditures for drugs was 28.9%. For the ability to engage, the overall median score on the HIV-ASES scale was 118.0 (IQR: 107-120), and 69.4% had high treatment compliance. Respondents who experienced drug toxicities were more likely to have poorer treatment compliance (OR = 2.12, P = 0.011).
In general, access to antiretroviral drugs for HIV/AIDS patients was relatively good, while their ability to reach and pay was unsatisfactory. There should be a great concern for health education intervention and geographical accessibility of antiretroviral drugs in healthcare institutions. Policy should focus on the impact of social discrimination and drug toxicity on access to antiretroviral drugs.
抗逆转录病毒药物对艾滋病毒/艾滋病患者至关重要，但我们对患者在获取这些药物时面临的现实障碍知之甚少。遵循勒维克框架，本研究描述了山东省艾滋病毒/艾滋病患者在获取抗逆转录病毒药物时的五种能力，即感知、寻求、获取、支付和参与的能力以及与之相关的因素。
采用便利抽样的方法，对山东省三家艾滋病指定医院的艾滋病毒/艾滋病患者进行了横断面问卷调查。我们分别使用灾难性成本法和艾滋病毒治疗依从性自我效能量表来评估患者的支付能力和参与能力。
共有301名参与者完成了问卷，其中20.9%的参与者CD4细胞计数低于200个/微升。在感知能力方面，只有16.6%的受访者自我报告对艾滋病毒进展和药物治疗的了解程度较低。在寻求能力方面，24.3%的人自我报告曾遭受社会歧视，21.9%的人表示“因担心隐私泄露而选择不寻求医保报销”。在获取能力方面，购买药物的平均花费时间为2.1±1.3小时，农村地区和受教育程度较低的受访者花费时间最长。在支付能力方面，药物灾难性医疗支出的总体发生率为28.9%。在参与能力方面，艾滋病毒治疗依从性自我效能量表的总体中位数为118.0（四分位间距：107-120），69.4%的患者治疗依从性高。经历过药物毒性的受访者治疗依从性较差的可能性更大（比值比=2.12，P=0.011）。
总体而言，艾滋病毒/艾滋病患者获取抗逆转录病毒药物的情况相对较好，但其获取和支付能力不尽人意。应高度关注医疗机构中的健康教育干预以及抗逆转录病毒药物的地理可及性。政策应关注社会歧视和药物毒性对获取抗逆转录病毒药物的影响。
