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.'
affiliation: 'Merten, S (Corresponding Author), Swiss Trop \& Publ Hlth Inst, Dept
  Epidemiol \& Publ Hlth, Basel, Switzerland.

  Gari, Sara; Martin-Hilber, Adriane; Merten, Sonja, Swiss Trop \& Publ Hlth Inst,
  Dept Epidemiol \& Publ Hlth, Basel, Switzerland.

  Gari, Sara; Martin-Hilber, Adriane; Merten, Sonja, Univ Basel, Basel, Switzerland.

  Doig-Acuna, Camilo, CUNY, Sophie Davis Sch Biomed Educ, New York, NY 10021 USA.

  Smail, Tino, Particip GmBH, Freiburg, Germany.

  Malungo, Jacob R. S., Univ Zambia, Dept Populat Studies, Lusaka, Zambia.'
article-number: '198'
author: Gari, Sara and Doig-Acuna, Camilo and Smail, Tino and Malungo, Jacob R. S.
  and Martin-Hilber, Adriane and Merten, Sonja
author-email: sonja.merten@unibas.ch
author_list:
- family: Gari
  given: Sara
- family: Doig-Acuna
  given: Camilo
- family: Smail
  given: Tino
- family: Malungo
  given: Jacob R. S.
- family: Martin-Hilber
  given: Adriane
- family: Merten
  given: Sonja
da: '2023-09-28'
doi: 10.1186/1472-6963-13-198
eissn: 1472-6963
files: []
journal: BMC HEALTH SERVICES RESEARCH
keywords: 'Socio-cultural barriers; Access; Adherence; HIV/AIDS; Antiretroviral

  therapy; Survey study; Systematic review'
keywords-plus: 'ANTIRETROVIRAL THERAPY ADHERENCE; PATIENT-REPORTED BARRIERS; SUB-SAHARAN

  AFRICA; MEDICATION ADHERENCE; HIV PATIENTS; HAART; NONADHERENCE;

  DEPRESSION; FAILURE; STIGMA'
language: English
month: MAY 28
number-of-cited-references: '45'
orcid-numbers: Merten, Sonja/0000-0003-4115-106X
papis_id: 190b3833072a2660f4e98b3e9cdae440
ref: Gari2013accesshivaids
tags:
- review
times-cited: '62'
title: 'Access to HIV/AIDS care: a systematic review of socio-cultural determinants
  in low and high income countries'
type: Review
unique-id: WOS:000320050100001
usage-count-last-180-days: '0'
usage-count-since-2013: '32'
volume: '13'
web-of-science-categories: Health Care Sciences \& Services
year: '2013'