Skip to main content

Does accessibility to antiretroviral care improve after down-referral of patients from hospitals to health centres in rural South Africa?

Publication ,  Journal Article
Moshabela, M; Schneider, H; Cleary, SM; Pronyk, PM; Eyles, J
Published in: African Journal of AIDS Research
December 1, 2011

We conducted an evaluation of healthcare accessibility among patients taking antiretroviral treatment (ART) after they were 'down-referred' from hospital-based programmes to primary healthcare (PHC) centres in a rural South African setting. A cross-sectional design was used to study 109 PHC users compared to a randomly selected control group of 220 hospital-based users. Both groups were matched for a minimum duration on ART of six months. Using a comprehensive healthcare-accessibility framework, the participants were asked about availability, affordability and acceptability of their ART care in structured exit interviews that were linked to their ART-clinic record reviews. Unadjusted and adjusted regression models were used. Down-referral was associated with reduced transportation and meal costs (p ≤ 0.001) and travel time to an ART facility (p = 0.043). The down-referred users were less likely to complain of long queues (adjusted odds ratio [AOR] 0.06; 95% confidence interval [95% CI]: 0.01-0.29), were more likely to feel respected by health providers (AOR 4.43; 95% CI: 1.07-18.02), perceived lower stigma (AOR 0.25; 95% CI: 0.07-0.91), and showed a higher level of ART adherence (AOR 8.71; 95% CI: 1.16-65.22) than the hospital-based users. However, the down-referred users preferred to consult with doctors rather than nurses (AOR 3.43; 95% CI: 1.22-9.55) and they were more likely to visit private physicians (AOR 7.09; 95% CI: 3.86-13.04) and practice self-care (AOR 4.91; 95% CI: 2.37-10.17), resulting in increased health-related expenditure (p ≤ 0.001). Therefore, the results indicate both gains and losses in ART care for the patients, and suggest that down-referred patients save time and money, feel more respected, perceive lower stigma and show better adherence levels. However, unintended consequences include increased costs of using private physicians and self-care, highlighting the need to further promote the potential gains of down-referral interventions in resource-poor settings. Copyright © NISC (Pty) Ltd.

Duke Scholars

Published In

African Journal of AIDS Research

DOI

EISSN

1727-9445

ISSN

1608-5906

Publication Date

December 1, 2011

Volume

10

Issue

4

Start / End Page

393 / 401

Related Subject Headings

  • Public Health
  • 42 Health sciences
  • 32 Biomedical and clinical sciences
  • 11 Medical and Health Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Moshabela, M., Schneider, H., Cleary, S. M., Pronyk, P. M., & Eyles, J. (2011). Does accessibility to antiretroviral care improve after down-referral of patients from hospitals to health centres in rural South Africa? African Journal of AIDS Research, 10(4), 393–401. https://doi.org/10.2989/16085906.2011.646654
Moshabela, M., H. Schneider, S. M. Cleary, P. M. Pronyk, and J. Eyles. “Does accessibility to antiretroviral care improve after down-referral of patients from hospitals to health centres in rural South Africa?African Journal of AIDS Research 10, no. 4 (December 1, 2011): 393–401. https://doi.org/10.2989/16085906.2011.646654.
Moshabela M, Schneider H, Cleary SM, Pronyk PM, Eyles J. Does accessibility to antiretroviral care improve after down-referral of patients from hospitals to health centres in rural South Africa? African Journal of AIDS Research. 2011 Dec 1;10(4):393–401.
Moshabela, M., et al. “Does accessibility to antiretroviral care improve after down-referral of patients from hospitals to health centres in rural South Africa?African Journal of AIDS Research, vol. 10, no. 4, Dec. 2011, pp. 393–401. Scopus, doi:10.2989/16085906.2011.646654.
Moshabela M, Schneider H, Cleary SM, Pronyk PM, Eyles J. Does accessibility to antiretroviral care improve after down-referral of patients from hospitals to health centres in rural South Africa? African Journal of AIDS Research. 2011 Dec 1;10(4):393–401.

Published In

African Journal of AIDS Research

DOI

EISSN

1727-9445

ISSN

1608-5906

Publication Date

December 1, 2011

Volume

10

Issue

4

Start / End Page

393 / 401

Related Subject Headings

  • Public Health
  • 42 Health sciences
  • 32 Biomedical and clinical sciences
  • 11 Medical and Health Sciences