Who is utilizing anti-retroviral therapy in Ghana: An analysis of ART service utilization

Dako-Gyeke Phyllis, Snow Rachel, Yawson

Description

The global scale-up of antiretroviral therapy (ART) for HIV patients has led to concerns regarding inequities in utilization of ART services in resource-limited contexts. In this paper, we describe regional and sex differentials in the distribution of ART among adult HIV patients in Ghana. We highlight the need for interventions to address the gender-based and geographic inequities related to the utilization of ART services in Ghana. Methods We reviewed National AIDS/STIs Control Program’s ART service provision records from January 2003 through December 2010, extracting data on adults aged 15+ who initiated ART in Ghana over a period of eight years. Data on the number of patients on treatment, year of enrollment, sex, and region were obtained and compared. Results The number of HIV patients receiving ART in Ghana increased more than 200-fold from 197 in 2003, to over 45,000 in 2010. However, for each of six continuous years (2005-2010) males comprised approximately one-third of adults newly enrolled on ART. As ART coverage has expanded in Ghana, the proportion of males receiving ART declined from 41.7% in 2004 to 30.1% in 2008 and to 27.6% in 2010. Also, there is disproportionate regional ART utilization across the country. Some regions report ART enrollment lower than their percent share of number of HIV infected persons in the country. Conclusions Attention to the comparatively fewer males initiating ART, as well as disproportionate regional ART utilization is urgently needed. All forms of gender-based inequities in relation to HIV care must be addressed in order for Ghana to realize successful outcomes at the population level. Policy makers in Ghana and elsewhere need to understand how gender-based health inequities in relation to HIV care affect both men and women and begin to design appropriate interventions.

Sujets

• ART
• Utilization
• Sex
• Regional
• Ghana

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 5
• Langue: English

Extrait

Macinko and LimaCostaInternational Journal for Equity in Health2012,11:33 http://www.equityhealthj.com/content/11/1/33

R E S E A R C H

Horizontal equity in health Brazil, 1998–2008 1* 2 James Macinko and Maria Fernanda LimaCosta

care

utilization

Open Access

in

Abstract Introduction:This study assesses trends in horizontal equity in the utilization of healthcare services from 1998 to 2008a period of major economic and social change in Brazil. Methods:Data are from nationally representative surveys repeated in 1998, 2003, and 2008. We apply established methods for assessing horizontal inequity in healthcare access (the principle that people with the same healthcare needs should have similar access to healthcare services). Horizontal inequity is calculated as the difference between observed healthcare utilization and utilization predicted by healthcare needs. Outcomes examined include the probability of a medical, dental, or hospital visit during the past 12 months; any health service use in the past two weeks; and having a usual source of healthcare. We use monthly family income to measure differences in socioeconomic position. Healthcare needs include age, sex, selfrated health, and chronic conditions. Nonneed factors include income, education, geography, health insurance, and Family Health Strategy coverage. Results:The probability of having at least one doctor visit in the past 12 months became substantially more equitable over time, ending with a slightly prorich orientation in 2008. Any hospitalization in the past 12 months was found to be propoor in all periods but became slightly less so in 2008. Dental visits showed the largest absolute decrease in horizontal inequity, although they were still the most inequitably (prorich) distributed outcome in 2008. Service use in the past two weeks showed decreased inequity in 2003 but exhibited no significant change between 2003 and 2008. Having a usual source of care became less prorich over time and was nearly incomeneutral by 2008. Factors associated with greater inequities include income, having a private health plan, and geographic location. Factors associated with greater equity included health needs, schooling, and enrolment in the Family Health Strategy. Conclusions:Healthcare utilization in Brazil appears to have become increasingly equitable over the past 10 years. Although this does not imply that equity in health outcomes has improved correspondingly, it does suggest that government policies aimed at increasing access, especially to primary care, have helped to make healthcare utilization in Brazil fairer over time. Keywords:Healthcare, Brazil, Access to care, Primary care

Introduction There are considerable income disparities in Brazil, as reflected by one of the world’s highest Gini indices: 0.54 in 2009 [1]. There is also evidence of socioeconomic dis parities in access to and use of healthcare [2,3]. Health disparities are particularly relevant as Brazil continues to develop its national health system (theSistema Unico de

* Correspondence: [e-mail] 1 Department of Nutrition, Food Studies & Public Health, New York University, 411 Lafayette Street, 5th Floor, New York, NY 10003, USA Full list of author information is available at the end of the article

Saúdeor SUS). Created in 1988, the SUS was conceived of as a national health service designed to provide com prehensive and universal care through decentralized management and provision of health services that are free of charge at the point of delivery. As of 2010 the SUS contained over 41,000 health posts and centers, 30,000 specialized outpatient services, nearly 2,000 pub lic hospitals, and 236,000 community health agents [4]. In 2009 the SUS financed nearly 12 million hospitaliza tions and delivered about 100 million ambulatory care procedures per month [4]. In addition to the SUS, about

© 2012 Macinko and LimaCosta; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.