title: Access to HIV/AIDS care: a systematic review of socio-cultural determinants in low and high income countries.
abstract: BACKGROUND
  The role of socio-cultural factors in influencing access to HIV/AIDS treatment, care and support is increasingly recognized by researchers, international donors and policy makers. Although many of them have been identified through qualitative studies, the evidence gathered by quantitative studies has not been systematically analysed. To fill this knowledge gap, we did a systematic review of quantitative studies comparing surveys done in high and low income countries to assess the extent to which socio-cultural determinants of access, identified through qualitative studies, have been addressed in epidemiological survey studies.
  
  
  METHODS
  Ten electronic databases were searched (Cinahl, EMBASE, ISI Web of Science, IBSS, JSTOR, MedLine, Psyinfo, Psyindex and Cochrane). Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Meta-analysis was used to synthesize data comparing studies between low and high income countries.
  
  
  RESULTS
  Thirty-four studies were included in the final review, 21 (62%) done in high income countries and 13 (38%) in low income countries. In low income settings, epidemiological research on access to HIV/AIDS services focused on socio-economic and health system factors while in high income countries the focus was on medical and psychosocial factors. These differences depict the perceived different barriers in the two regions. Common factors between the two regions were also found to affect HIV testing, including stigma, high risk sexual behaviours such as multiple sexual partners and not using condoms, and alcohol abuse. On the other hand, having experienced previous illness or other health conditions and good family communication was associated with adherence to ART uptake. Due to insufficient consistent data, a meta-analysis was only possible on adherence to treatment.
  
  
  CONCLUSIONS
  This review offers evidence of the current challenges for interdisciplinary work in epidemiology and public health. Quantitative studies did not systematically address in their surveys important factors identified in qualitative studies as playing a critical role on the access to HIV/AIDS services. The evidences suggest that the problem lies in the exclusion of the qualitative information during the questionnaire design. With the changing face of the epidemic, we need a new and improved research strategy that integrates the results of qualitative studies into quantitative surveys.
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Sara
authors.initials: S
authors.lastname: Gari
authors.forename: Camilo
authors.initials: C
authors.lastname: Doig-Acuña
authors.forename: Tino
authors.initials: T
authors.lastname: Smail
authors.forename: Jacob R S
authors.initials: JR
authors.lastname: Malungo
authors.forename: Adriane
authors.initials: A
authors.lastname: Martin-Hilber
authors.forename: Sonja
authors.initials: S
authors.lastname: Merten
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D012959:Socioeconomic Factors
chemical_list: D044966:Anti-Retroviral Agents