title: Socio-economic and health characteristics of HIV-infected patients seeking care in relation to access to the Drug Access Initiative and to antiretroviral treatment in Côte d'Ivoire.
abstract: OBJECTIVE
  To compare socio-economic and health characteristics of HIV-infected patients in Côte d'Ivoire whether or not they had access to the Drug Access Initiative (DAI) and to antiretroviral drug (ARV) treatment.
  
  
  METHODS
  Cross-sectional survey using medical files, blood sampling for CD4 cell counts and face-to-face interviews among all patients, informed of their HIV status, who attended during a 6-week period in the five DAI referral centres and three additional centres in charge of HIV care in Abidjan and Bouaké (participation rate = 65.4%). Multiple logistic regression using generalized estimating equations (GEE) to identify factors related to non-access to DAI and to ARV treatment.
  
  
  RESULTS
  Among the 711 respondents, 23.0% were ARV-treated, 14.2% had been included in the DAI but were still waiting for initiation of ARV, and 62.7% were neither part of the DAI nor ARV-treated. In this latter group, less than one-third (29.6%) declared that they knew about the existence of the DAI. Among the 164 ARV-treated patients, 59.1% had benefited from DAI public subsidies partially covering the costs of drugs. In the non-DAI-non-ARV-treated group, 86% could have qualified for ARV treatment according to the DAI medical criteria (CD4 cell counts < 500 x 10(6) cells/l), and only 32.9% of those medically eligible were prescribed cotrimoxazole prophylaxis. In multivariate analysis, not being in the DAI and not being ARV-treated was related to: being a male, not having health care insurance, having a low level of education, living in poor housing conditions (absence of refrigerator in the household, absence of ventilation in patient's bedroom), and not being under cotrimoxazole prophylaxis.
  
  
  CONCLUSIONS
  The Ivoirian DAI has facilitated access to ARV treatment for a significant number of patients with limited ability to pay. The majority of HIV-infected patients seeking care however face persisting socio-economic and informational barriers to access to these treatments.
authors.affiliation: Institute for Research & Development (LPE/IRD), University of Provence, Marseille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Msellati
authors.forename: Anne
authors.initials: A
authors.lastname: Juillet-Amari
authors.forename: Joanne
authors.initials: J
authors.lastname: Prudhomme
authors.forename: Hortense Aka-Dago
authors.initials: HA
authors.lastname: Akribi
authors.forename: Djénéba
authors.initials: D
authors.lastname: Coulibaly-Traore
authors.forename: Marc
authors.initials: M
authors.lastname: Souville
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Moatti
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000600:supply & distribution* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006297:Health Services Accessibility; D006798:Housing; D006801:Humans; D016015:Logistic Models; D008297:Male; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D012923:Social Class
chemical_list: D019380:Anti-HIV Agents