Impact of Socioeconomic Inequality on Access, Adherence, and Outcomes of Antiretroviral Treatment Services for People Living with HIV/AIDS in Vietnam.

Bach Xuan Tran,Noah Reed Knowlton Latkin,Vu Thi Minh Thuc,Long Hoang Nguyen,Tho Dinh Tran,Carl A Latkin,Ngoc Kim Tran,Jongnam Hwang,Anh Tuan Nguyen,Huong Thi Le,Huong Thu Thi Phan,Huong Lan Thi Nguyen

doi:10.1371/journal.pone.0168687

Abstract

BackgroundEnsuring an equal benefit across different patient groups is necessary while scaling up free-of-charge antiretroviral treatment (ART) services. This study aimed to measure the disparity in access, adherence, and outcomes of ART in Vietnam and the effects of socioeconomic status (SES) characteristics on the levels of inequality.MethodsA cross-sectional study was conducted in 1133 PLWH in Vietnam. ART access, adherence, and treatment outcomes were self-reported using a structured questionnaire. Wealth-related inequality was calculated using a concentration index, and a decomposition analysis was used to determine the contribution of each SES variable to inequality in access, adherence, and outcomes of ART.ResultsBased on SES, minor inequality was found in ART access and adherence while there was considerable inequality in ART outcomes. Poor people were more likely to start treatment early, while rich people had better adherence and overall treatment outcomes. Decomposition revealed that occupation and education played important roles in inequality in ART access, adherence, and treatment outcomesConclusionThe findings suggested that health services should be integrated into the ART regimen. Furthermore, occupational orientation and training courses should be provided to reduce inequality in ART access, adherence, and treatment outcomes.

Highlights

A rapid scale-up of antiretroviral therapy (ART) service has sustainably contributed to diminishing the burden of HIV epidemic in both individual and social perspectives [1,2,3]
Based on socioeconomic status (SES), minor inequality was found in antiretroviral treatment (ART) access and adherence while there was considerable inequality in ART outcomes
Decomposition revealed that occupation and education played important roles in inequality in ART access, adherence, and treatment outcomes

Summary

Introduction

A rapid scale-up of antiretroviral therapy (ART) service has sustainably contributed to diminishing the burden of HIV epidemic in both individual and social perspectives [1,2,3]. By the end of 2015, over 17 million people living with HIV (PLWHs) worldwide were on ART, two million of whom initiated their treatment the same year [4]. International research suggests that lower socioeconomic status (SES) was closely related to delayed ART initiation, lower treatment adherence, and poorer outcomes [11,12,13,14]. Since socioeconomically disadvantaged groups have been extremely vulnerable to the HIV epidemic, the impacts of SES on access, adherence and outcomes of antiretroviral treatment services among PLWH should be carefully elucidated. This study aimed to measure the disparity in access, adherence, and outcomes of ART in Vietnam and the effects of socioeconomic status (SES) characteristics on the levels of inequality

Objectives

Methods

Results

Discussion

Conclusion