Objective To test the hypothesis that increasing community ART coverage would be associated with lower HIV incidence in female sex workers (FSWs) in Mombasa District, Kenya. Design Prospective cohort study. Methods From 1998–2012, HIV-negative FSWs were asked to return monthly for an interview regarding risk behavior and testing for sexually transmitted infections including HIV. We evaluated the association between community ART coverage and FSW’s risk of becoming HIV infected using Cox proportional hazards models adjusted for potential confounding factors. Results 1,404 FSWs contributed 4,335 woman-years of follow-up, with 145 acquiring HIV infection (incidence 3.35/100 woman-years). The ART rollout began in 2003. By 2012, an estimated 52% of HIV-positive individuals were receiving treatment. Community ART coverage was inversely associated with HIV incidence (adjusted hazard ratio [aHR] 0.77; 95% confidence interval [95%CI] 0.61–0.98; p=0.03), suggesting that each 10% increase in coverage was associated with a 23% reduction in FSWs’ risk of HIV acquisition. Community ART coverage had no impact on HSV-2 incidence (aHR 0.97; 95%CI 0.79–1.20; p=0.8). Conclusions Increasing general population ART coverage was associated with lower HIV incidence in FSWs. The association with HIV incidence, but not HSV-2 incidence, suggests that the effect of community ART coverage may be specific to HIV. Interventions such as pre-exposure prophylaxis and antiretroviral-containing microbicides have produced disappointing results in HIV prevention trials with FSWs. These results suggest that FSWs’ risk of acquiring HIV infection might be reduced through the indirect approach of increasing ART coverage in the community.
Universal health coverage promotes access to necessary care and protects patients from health-related financial hardship that may affect health outcomes. The World Health Organization declared that governments are obligated to promote universal coverage of essential health care services, including prescription drugs. [1][2][3][4] Given the importance of reducing out-of-pocket spending for prescription drugs, universal access to affordable, safe and appropriately prescribed treatments is an important goal for health systems in all countries. 2-5 However, approaches to universal health coverage for prescription medications or universal pharmacare varies according to the population covered (who), health products and technologies (what) and the extent of coverage (proportion of direct costs covered). The amount spent on prescription drugs, including per capita spending, has significantly increased over time. [4][5][6][7] Health system expenditure on prescription drugs has also increased in many countries, often growing faster than other health system costs. [5][6][7][8][9][10][11][12][13][14] Therefore, implementing universal pharmacare can enhance equitable access to needed care and medicines, which is central to the ongoing debate about the need for a national pharmacare program in Canada. 11 Although Canada's provincial and territorial health systems provide a single-payer system with coverage for medically necessary hospital and physician-based care, this universality does not extend to outpatient prescription medications. [2][3][4][5] Instead, prescription drugs are funded by a fragmented patchwork of public and private drug plans that varies by province and leaves many Canadians with little or no drug coverage. [4][5][6] Children and youth are a vulnerable population, and studies that have investigated coverage variation have shown that younger adults are the most disadvantaged in coverage. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] In
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.