title: Equity in utilization of antiretroviral therapy for HIV-infected people in South Africa: a systematic review.
abstract: BACKGROUND
  About half a million people in South Africa are deprived of antiretroviral therapy (ART), and there is little systematic knowledge on who they are - e.g. by severity of disease, sex, or socio-economic status (SES). We performed a systematic review to determine the current quantitative evidence-base on equity in utilization of ART among HIV-infected people in South Africa.
  
  
  METHODS
  We conducted a literature search based on the Cochrane guidelines. A study was included if it compared for different groups of HIV infected people (by sex, age, severity of disease, area of living, SES, marital status, ethnicity, religion and/or sexual orientation (i.e. equity criteria)) the number initiating/adhering to ART with the number who did not. We considered ART utilization inequitable for a certain criterion (e.g. sex) if between groups (e.g. men versus women) significant differences were reported in ART initiation/adherence.
  
  
  RESULTS
  Twelve studies met the inclusion criteria. For sex, 2 out of 10 studies that investigated this criterion found that men are less likely than women to utilize ART, while the other 8 found no differences. For age, 4 out of 8 studies found inequities and reported less utilization for younger people. For area of living, 3 out of 4 studies showed that those living in rural areas or certain provinces have less access and 2 out of 6 studies looking at SES found that people with lower SES have less access. One study which looked at the marital status found that those who are married are less likely to utilize ART. For severity of disease, 5 out of 6 studies used more than one outcome measure for disease stage and reported within their study contradicting results. One of the studies reported inconclusive findings for ethnicity and no study had looked at religion and sexual orientation.
  
  
  CONCLUSIONS
  It seems that men, young people, those living in certain provinces or rural areas, people who are unemployed or with a low educational level, and those being unmarried have less access to ART. As studies stem from different contexts and use different methods conclusions should be taken with caution.
authors: Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands. noor.tromp@radboudumc.nl.
authors: Noor
authors: N
authors: Tromp
authors: Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands. charlottemichels@student.ru.nl.
authors: Charlotte
authors: C
authors: Michels
authors: Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands. Evelinn.Mikkelsen@radboudumc.nl.
authors: Evelinn
authors: E
authors: Mikkelsen
authors: Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands. j.hontelez@erasmusmc.nl.|Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. j.hontelez@erasmusmc.nl.
authors: Jan
authors: J
authors: Hontelez
authors: Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands. rob.baltussen@radboudumc.nl.
authors: Rob
authors: R
authors: Baltussen
mesh_terms: D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D012424:Rural Population; D012737:Sex Factors; D012959:Socioeconomic Factors; D013019:South Africa