Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/44837
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Type: | Journal article |
Title: | How far will we need to go to reach HIV-infected people in rural South Africa? |
Author: | Wilson, D. Blower, S. |
Citation: | BMC Medicine, 2007; 5(16):www1-www5 |
Publisher: | BioMed Central Ltd. |
Issue Date: | 2007 |
ISSN: | 1741-7015 1741-7015 |
Statement of Responsibility: | David P Wilson and Sally Blower |
Abstract: | Background: The South African Government has outlined detailed plans for antiretroviral (ART) rollout in KwaZulu-Natal Province, but has not created a plan to address treatment accessibility in rural areas in KwaZulu-Natal. Here, we calculate the distance that People Living With HIV/AIDS (PLWHA) in rural areas in KwaZulu-Natal would have to travel to receive ART. Specifically, we address the health policy question 'How far will we need to go to reach PLWHA in rural KwaZulu-Natal?'. Methods: We developed a model to quantify treatment accessibility in rural areas; the model incorporates heterogeneity in spatial location of HCFs and patient population. We defined treatment accessibility in terms of the number of PLWHA that have access to an HCF. We modeled the treatment-accessibility region (i.e. catchment area) around an HCF by using a two-dimensional function, and assumed that treatment accessibility decreases as distance from an HCF increases. Specifically, we used a distance-discounting measure of ART accessibility based upon a modified form of a two-dimensional gravity-type model. We calculated the effect on treatment accessibility of: (1) distance from an HCF, and (2) the number of HCFs. Results: In rural areas in KwaZulu-Natal even substantially increasing the size of a small catchment area (e.g. from 1 km to 20 km) around an HCF would have a negligible impact (~2%) on increasing treatment accessibility. The percentage of PLWHA who can receive ART in rural areas in this province could be as low as ~16%. Even if individuals were willing (and able) to travel 50 km to receive ART, only ~50% of those in need would be able to access treatment. Surprisingly, we show that increasing the number of available HCFs for ART distribution ~ threefold does not lead to a threefold increase in treatment accessibility in rural KwaZulu-Natal. Conclusion: Our results show that many PLWHA in rural KwaZulu-Natal are unlikely to have access to ART, and that the impact of an additional 37 HCFs on treatment accessibility in rural areas would be less substantial than might be expected. There is a great length to go before we will be able to reach many PLWHA in rural areas in South Africa, and specifically in KwaZulu-Natal. |
Keywords: | Humans HIV Infections Anti-Retroviral Agents Treatment Outcome Models, Statistical Public Health Geography Models, Theoretical Health Policy Rural Population Health Planning Health Services Accessibility South Africa |
Rights: | Copyright © 2007 Wilson and Blower; 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. |
DOI: | 10.1186/1741-7015-5-16 |
Published version: | http://www.biomedcentral.com/1741-7015/5/16 |
Appears in Collections: | Aurora harvest Molecular and Biomedical Science publications |
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hdl_44837.pdf | Published version | 420.08 kB | Adobe PDF | View/Open |
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