Disparities in healthcare access and utilization among people living with HIV in China: A scoping review and meta-analysis

Wei Ai; Chengxin Fan; Gifty Marley; Rayner K.J. Tan; Dan Wu; Jason J. Ong; Joseph D. Tucker; Gengfeng Fu; Weiming Tang

doi:10.1111/hiv.13523

Disparities in healthcare access and utilization among people living with HIV in China: A scoping review and meta-analysis

Wei Ai, Chengxin Fan, Gifty Marley, Rayner K.J. Tan, Dan Wu, Jason J. Ong, Joseph D. Tucker, Gengfeng Fu, Weiming Tang

Research output: Contribution to journal › Review Article › Research › peer-review

5 Citations (Scopus)

Abstract

Background: This review aims to assess the status of healthcare disparities among people living with HIV (PLWH) in China and summarize the factors that drive them. Methods: We searched PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI) and China Wanfang for studies published in English or Chinese. Studies focusing on any disparities in healthcare services among PLWH in China and published between January 2000 and July 2022 were included. Results: In all, 51 articles met the inclusion criteria, with 37 studies reporting HIV-focused care, and 14 reporting non-HIV-focused care. PLWH aged ≥45 years (vs. <45 years), female (vs. male), ethnic minority (vs. Han), and cases attributed to sexual transmission (vs. injecting drug use) were more likely to receive ART. Females living with HIV have higher ART adherence than males. Notably, 20% [95% confidence interval (CI): 9–43%, I² = 96%] of PLWH reported any illness in the previous 2 weeks without medical consultation, and 30% (95% CI: 12–74%, I² = 90%) refused hospitalization when needed in the previous year. Barriers to HIV-focused care included inadequate HIV/ART knowledge and treatment side effects at the individual level; and social discrimination and physician–patient relationships at the community/social level. Structural barriers included medical costs and transportation issues. The most frequently reported barriers to non-HIV-focused care were financial constraints and the perceived need for medical services at individual-level factors; and discrimination from physicians, and medical distrust at the community/social level. Conclusion: This review suggests disparities in access and utilization of healthcare among PLWH. Financial issues and social discrimination were prominent reasons. Creating a supportive social environment and expanding insurance policies could be considered to promote healthcare equity.

Original language	English
Pages (from-to)	1093-1105
Number of pages	13
Journal	HIV Medicine
Volume	24
Issue number	11
DOIs	https://doi.org/10.1111/hiv.13523
Publication status	Published - Nov 2023

Keywords

antiretroviral therapy
healthcare disparities
healthcare utilization
HIV care
non-HIV care
PLWH

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/hiv.13523

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@article{8f62e6a374e94c068d871ac50dd17bb3,

title = "Disparities in healthcare access and utilization among people living with HIV in China: A scoping review and meta-analysis",

abstract = "Background: This review aims to assess the status of healthcare disparities among people living with HIV (PLWH) in China and summarize the factors that drive them. Methods: We searched PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI) and China Wanfang for studies published in English or Chinese. Studies focusing on any disparities in healthcare services among PLWH in China and published between January 2000 and July 2022 were included. Results: In all, 51 articles met the inclusion criteria, with 37 studies reporting HIV-focused care, and 14 reporting non-HIV-focused care. PLWH aged ≥45 years (vs. <45 years), female (vs. male), ethnic minority (vs. Han), and cases attributed to sexual transmission (vs. injecting drug use) were more likely to receive ART. Females living with HIV have higher ART adherence than males. Notably, 20% [95% confidence interval (CI): 9–43%, I2 = 96%] of PLWH reported any illness in the previous 2 weeks without medical consultation, and 30% (95% CI: 12–74%, I2 = 90%) refused hospitalization when needed in the previous year. Barriers to HIV-focused care included inadequate HIV/ART knowledge and treatment side effects at the individual level; and social discrimination and physician–patient relationships at the community/social level. Structural barriers included medical costs and transportation issues. The most frequently reported barriers to non-HIV-focused care were financial constraints and the perceived need for medical services at individual-level factors; and discrimination from physicians, and medical distrust at the community/social level. Conclusion: This review suggests disparities in access and utilization of healthcare among PLWH. Financial issues and social discrimination were prominent reasons. Creating a supportive social environment and expanding insurance policies could be considered to promote healthcare equity.",

keywords = "antiretroviral therapy, healthcare disparities, healthcare utilization, HIV care, non-HIV care, PLWH",

author = "Wei Ai and Chengxin Fan and Gifty Marley and Tan, {Rayner K.J.} and Dan Wu and Ong, {Jason J.} and Tucker, {Joseph D.} and Gengfeng Fu and Weiming Tang",

note = "Funding Information: This work was supported by the Key Technologies Research and Development Program (2022YFC2304900‐4 to Weiming Tang), National Institute of Health (R34MH119963 to WT), National Nature Science Foundation of China (81903371 to Weiming Tang), and CRDF Global (G‐202104‐67775 to WT). The funders had no role in the study design, data collection, analysis, decision to publish or preparation of the manuscript. Publisher Copyright: {\textcopyright} 2023 British HIV Association.",

year = "2023",

month = nov,

doi = "10.1111/hiv.13523",

language = "English",

volume = "24",

pages = "1093--1105",

journal = "HIV Medicine",

issn = "1464-2662",

publisher = "Wiley-Blackwell",

number = "11",

}

TY - JOUR

T1 - Disparities in healthcare access and utilization among people living with HIV in China

T2 - A scoping review and meta-analysis

AU - Ai, Wei

AU - Fan, Chengxin

AU - Marley, Gifty

AU - Tan, Rayner K.J.

AU - Wu, Dan

AU - Ong, Jason J.

AU - Tucker, Joseph D.

AU - Fu, Gengfeng

AU - Tang, Weiming

N1 - Funding Information: This work was supported by the Key Technologies Research and Development Program (2022YFC2304900‐4 to Weiming Tang), National Institute of Health (R34MH119963 to WT), National Nature Science Foundation of China (81903371 to Weiming Tang), and CRDF Global (G‐202104‐67775 to WT). The funders had no role in the study design, data collection, analysis, decision to publish or preparation of the manuscript. Publisher Copyright: © 2023 British HIV Association.

PY - 2023/11

Y1 - 2023/11

N2 - Background: This review aims to assess the status of healthcare disparities among people living with HIV (PLWH) in China and summarize the factors that drive them. Methods: We searched PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI) and China Wanfang for studies published in English or Chinese. Studies focusing on any disparities in healthcare services among PLWH in China and published between January 2000 and July 2022 were included. Results: In all, 51 articles met the inclusion criteria, with 37 studies reporting HIV-focused care, and 14 reporting non-HIV-focused care. PLWH aged ≥45 years (vs. <45 years), female (vs. male), ethnic minority (vs. Han), and cases attributed to sexual transmission (vs. injecting drug use) were more likely to receive ART. Females living with HIV have higher ART adherence than males. Notably, 20% [95% confidence interval (CI): 9–43%, I2 = 96%] of PLWH reported any illness in the previous 2 weeks without medical consultation, and 30% (95% CI: 12–74%, I2 = 90%) refused hospitalization when needed in the previous year. Barriers to HIV-focused care included inadequate HIV/ART knowledge and treatment side effects at the individual level; and social discrimination and physician–patient relationships at the community/social level. Structural barriers included medical costs and transportation issues. The most frequently reported barriers to non-HIV-focused care were financial constraints and the perceived need for medical services at individual-level factors; and discrimination from physicians, and medical distrust at the community/social level. Conclusion: This review suggests disparities in access and utilization of healthcare among PLWH. Financial issues and social discrimination were prominent reasons. Creating a supportive social environment and expanding insurance policies could be considered to promote healthcare equity.

AB - Background: This review aims to assess the status of healthcare disparities among people living with HIV (PLWH) in China and summarize the factors that drive them. Methods: We searched PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI) and China Wanfang for studies published in English or Chinese. Studies focusing on any disparities in healthcare services among PLWH in China and published between January 2000 and July 2022 were included. Results: In all, 51 articles met the inclusion criteria, with 37 studies reporting HIV-focused care, and 14 reporting non-HIV-focused care. PLWH aged ≥45 years (vs. <45 years), female (vs. male), ethnic minority (vs. Han), and cases attributed to sexual transmission (vs. injecting drug use) were more likely to receive ART. Females living with HIV have higher ART adherence than males. Notably, 20% [95% confidence interval (CI): 9–43%, I2 = 96%] of PLWH reported any illness in the previous 2 weeks without medical consultation, and 30% (95% CI: 12–74%, I2 = 90%) refused hospitalization when needed in the previous year. Barriers to HIV-focused care included inadequate HIV/ART knowledge and treatment side effects at the individual level; and social discrimination and physician–patient relationships at the community/social level. Structural barriers included medical costs and transportation issues. The most frequently reported barriers to non-HIV-focused care were financial constraints and the perceived need for medical services at individual-level factors; and discrimination from physicians, and medical distrust at the community/social level. Conclusion: This review suggests disparities in access and utilization of healthcare among PLWH. Financial issues and social discrimination were prominent reasons. Creating a supportive social environment and expanding insurance policies could be considered to promote healthcare equity.

KW - antiretroviral therapy

KW - healthcare disparities

KW - healthcare utilization

KW - HIV care

KW - non-HIV care

KW - PLWH

UR - http://www.scopus.com/inward/record.url?scp=85164308430&partnerID=8YFLogxK

U2 - 10.1111/hiv.13523

DO - 10.1111/hiv.13523

M3 - Review Article

C2 - 37407253

AN - SCOPUS:85164308430

SN - 1464-2662

VL - 24

SP - 1093

EP - 1105

JO - HIV Medicine

JF - HIV Medicine

IS - 11

ER -

Disparities in healthcare access and utilization among people living with HIV in China: A scoping review and meta-analysis

Abstract

Keywords

UN SDGs

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