Perceived barriers to the implementation of Isoniazid preventive therapy for people living with HIV in resource constrained settings: a qualitative study
Perceived barriers to the implementation of Isoniazid preventive therapy for people living with HIV in resource constrained settings: a qualitative study
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DOI：
10.11604/pamj.2014.17.26.2641
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发表时间：
2014-01-17
影响因子：
1.2
通讯作者：
Biadgilign, Sibhatu
中科院分区：
文献类型：
--
作者：
Mindachew, Mesele;Deribew, Amare;Biadgilign, Sibhatu
引言：异烟肼预防治疗（IPT）可降低活动性结核病的风险。IPT是在艾滋病毒感染者中预防结核病的一项重要公共卫生干预措施，已被建议作为艾滋病毒和艾滋病综合护理战略的一部分。但是，它的执行非常缓慢，并受到若干障碍的阻碍。目的：本研究的目的是评估2010年在埃塞俄比亚亚的斯亚贝巴资源有限的环境中，对艾滋病毒感染者实施异烟肼预防性治疗的感知障碍。方法：采用半结构化访谈指南的定性研究方法进行深度访谈。访谈对象包括4家医院的12名关键举报人，包括抗逆转录病毒治疗护士、咨询师和协调员。深入访谈的每一环节都通过录音带和详细的笔记记录下来。采访是逐字逐句地记录下来的。数据是手工分析的。结果：发现患者依从性差是主要因素；以下问题被认为是依从性差的原因；健忘的;缺乏对病情的了解，患者不愿透露艾滋病毒血清状况，导致社会支持不足；潜在的精神健康问题导致错过或不定期的病人预约；由于互动质量有限，患者/医疗保健提供者关系薄弱；缺乏患者信息、患者授权和适当的IPT咨询；卫生官员和其他利益相关者对IPT药物依从性作为积极健康结果的关键重要性的强化不足。结论：在资源有限的情况下，IPT的实施面临着挑战。建议为卫生工作者提供培训/能力建设和提高认识机制，促进对患者的披露和社会支持。
Introduction: Isoniazid preventive therapy (IPT) reduces the risk of active TB. IPT is a key public health intervention for the prevention of TB among people living with HIV and has been recommended as part of a comprehensive HIV and AIDS care strategy. However, its implementation has been very slow and has been impeded by several barriers. Objective: The Objective of the study is to assess the perceived barriers to the implementation of Isoniazid preventive therapy for people living with HIV in resource constrained settings in Addis Ababa, Ethiopia in 2010. Methods: A qualitative study using a semi-structured interviewed guide was used for the in-depth interview. A total of 12 key informants including ART Nurse, counselors and coordinators found in four hospitals were included in the interview. Each session of the in-depth interview was recorded via audio tape and detailed notes. The interview was transcribed verbatim. The data was analyzed manually. Results: the findings revealed that poor patient adherence was a major factor; with the following issues cited as the reasons for poor adherence; forgetfulness; lack of understanding of condition and patient non- disclosure of HIV sero-status leading to insubstantial social support; underlying mental health issues resulting in missed or irregular patient appointments; weak patient/healthcare provider relationship due to limited quality interaction; lack of patient information, patient empowerment and proper counseling on IPT; and the deficient reinforcement by health officials and other stakeholders on the significance of IPT medication adherence as a critical for positive health outcomes. Conclusion: Uptake of the implementation of IPT is facing a challenge in resource limited settings. This recalled provision of training/capacity building and awareness creation mechanism for the health workers, facilitating disclosure and social support for the patients is recommended.