Okano Justin T, Low Andrea, Dullie Luckson, Mzumara Wongani, Nuwagaba-Biribonwoha Harriet, Blower Sally
Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, USA.
Commun Med (Lond). 2025 May 12;5(1):169. doi: 10.1038/s43856-025-00890-y.
UNAIDS proposes ending inequalities in access to HIV treatment. We use data from nationally-representative Population-Based HIV Impact Assessment (PHIA) surveys for Eswatini, Malawi, and Zambia to identify inequities in one-way travel-time to access antiretroviral therapy (ART) for people with HIV (PWH).
Using biometric data from the PHIAs, we construct Epidemic Surface Prevalence maps and estimate treatment coverage. Self-reported travel-time data were fit using logistic cumulative distribution functions. Multivariable logistic regression models were used to examine relationships between travel-time, urban-rural residency, age, and sex.
We find the majority of PWH on ART are women: Eswatini (69.4%), Malawi (64.8%), Zambia (63.0%). The majority on ART reside in rural areas in Malawi (74.6%) and Eswatini (71.0%), but in urban areas in Zambia (61.9%). Travel-time distribution functions show, on average, PWH in Eswatini have the shortest travel-times; travel-times in Malawi are slightly longer than in Zambia. 56.4% (Malawi), 50.5% (Zambia), and 37.4% (Eswatini) of treated individuals could not access ART within one hour; many travel more than two hours: 20.6% (Zambia), 19.0% (Malawi), 10.5% (Eswatini). In all countries, the odds of traveling one or more hours are significantly higher in rural than urban areas. In Eswatini and Zambia, women have significantly higher odds than men of traveling one or more hours.
Many PWH spend considerable time traveling to access ART. Substantial inequities exist, disadvantaging rural populations in all three countries, and women in Eswatini and Zambia. Achieving UNAIDS' goal will require identifying drivers of inequities and designing strategies to minimize them.
联合国艾滋病规划署提议消除在获得艾滋病毒治疗方面的不平等现象。我们使用来自斯威士兰、马拉维和赞比亚具有全国代表性的基于人群的艾滋病毒影响评估（PHIA）调查数据，来确定艾滋病毒感染者（PWH）前往获取抗逆转录病毒疗法（ART）的单程旅行时间方面的不平等情况。
利用PHIA的生物识别数据，我们构建了流行表面患病率地图并估计治疗覆盖率。自我报告的旅行时间数据使用逻辑累积分布函数进行拟合。多变量逻辑回归模型用于研究旅行时间、城乡居住情况、年龄和性别之间的关系。
我们发现接受抗逆转录病毒治疗的大多数艾滋病毒感染者是女性：斯威士兰为69.4%，马拉维为64.8%，赞比亚为63.0%。接受抗逆转录病毒治疗的大多数人居住在马拉维（74.6%）和斯威士兰（71.0%）的农村地区，但在赞比亚（61.9%）的城市地区。旅行时间分布函数显示，平均而言，斯威士兰的艾滋病毒感染者旅行时间最短；马拉维的旅行时间比赞比亚略长。56.4%（马拉维）、50.5%（赞比亚）和37.4%（斯威士兰）的接受治疗者无法在一小时内获得抗逆转录病毒疗法；许多人旅行超过两小时：20.6%（赞比亚）、19.0%（马拉维）、10.5%（斯威士兰）。在所有国家，农村地区旅行一小时或更长时间的几率显著高于城市地区。在斯威士兰和赞比亚，女性旅行一小时或更长时间的几率显著高于男性。
许多艾滋病毒感染者花费大量时间前往获取抗逆转录病毒疗法。存在严重的不平等现象，使所有三个国家的农村人口以及斯威士兰和赞比亚的女性处于不利地位。要实现联合国艾滋病规划署的目标，需要确定不平等的驱动因素并设计策略将其降至最低。
