Understanding Diagnostic Delays for Kaposi Sarcoma in Kenya: A Qualitative Study.
Understanding Diagnostic Delays for Kaposi Sarcoma in Kenya: A Qualitative Study.
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DOI：
10.1097/qai.0000000000003011
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发表时间：
2022-08-15
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影响因子：
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尽管在撒哈拉以南非洲地区，与艾滋病毒相关的卡波西肉瘤 (KS) 经常在晚期被诊断出来，但诊断延迟的原因尚未得到很好的描述。我们将 2016 年至 2019 年期间新诊断 KS 的 18 岁以上患者纳入位于肯尼亚西部的家长研究。然后，我们有目的地选择了 30 名具有不同疾病严重程度和地理位置的参与者来参加半结构化访谈。我们在开发用于此分析的密码本时采用了两种行为模型：情境信息、动机和行为 (sIMB) 框架和患者总延误的安徒生模型。然后我们使用框架分析来分析访谈。延迟诊断的最常见患者因素是缺乏 KS 意识、寻求传统治疗、缺乏个人效能、缺乏社会支持以及对癌症、皮肤活检、截肢和 HIV 诊断的恐惧。导致诊断延迟的卫生系统因素包括之前的负面医疗互动、错误诊断、缺乏体检、延迟转诊以及缺乏组织活检。财务限制是患者获得和接受护理的显着障碍。诊断的促进因素包括成为艾滋病毒护理网络的一部分、居住在医疗机构附近、对医疗保健系统的信任、治疗疼痛或毁容病变的愿望以及社会支持。患者和提供者缺乏 KS 意识、围绕诊断的耻辱以及卫生系统转诊延迟是达到 KS 诊断的障碍。为了改善 KS 的早期诊断，需要改进公共卫生活动、增加活检和病理学设施的可用性以及针对 KS 的医疗服务提供者培训。
Although HIV-associated Kaposi sarcoma (KS) is frequently diagnosed at an advanced stage in sub-Saharan Africa, reasons for diagnostic delays have not been well described. We enrolled patients >18 years with newly diagnosed KS between 2016–2019 into the parent study, based in Western Kenya. We then purposively selected 30 participants with diversity of disease severity and geographic locations to participate in semi-structured interviews. We employed two behavioral models in developing the codebook for this analysis: situated Information, Motivation and Behavior (sIMB) framework and Andersen model of total patient delay. We then analyzed the interviews using framework analysis. The most common patient factors that delayed diagnosis were lack of KS awareness, seeking traditional treatments, lack of personal efficacy, lack of social support, and fear of cancer, skin biopsy, amputation, and HIV diagnosis. Health system factors that delayed diagnosis included prior negative healthcare interactions, incorrect diagnoses, lack of physical exam, delayed referral, and lack of tissue biopsy availability. Financial constraints were prominent barriers for patients to access and receive care. Facilitators for diagnosis included being part of an HIV care network, living near health facilities, trust in the healthcare system, desire to treat painful or disfiguring lesions, and social support. Lack of KS awareness among patients and providers, stigma surrounding diagnoses, and health system referral delays were barriers in reaching KS diagnosis. Improved public health campaigns, increased availability of biopsy and pathology facilities, and health provider training about KS are needed to improve early diagnosis of KS.
影响因子：
10.9
作者：
McMahon DE;Laker-Oketta M;Peters GA;McMahon PW;Oyesiku L;Freeman EE
通讯作者：
Freeman EE