Understanding reasons for discontinued antiretroviral treatment among clients in test and treat: a qualitative study in Swaziland.
Understanding reasons for discontinued antiretroviral treatment among clients in test and treat: a qualitative study in Swaziland.
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DOI：
10.1002/jia2.25120
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发表时间：
2018-07
影响因子：
6
通讯作者：
Reis R
中科院分区：
文献类型：
--
作者：
Shabalala FS;Vernooij E;Pell C;Simelane N;Masilela N;Spiegelman D;Chai B;Khan S;Reis R
坚持抗逆转录病毒疗法（ART）对于撒哈拉以南非洲国家成功采用检测和治疗政策以及实现联合国艾滋病毒和艾滋病方案的90 - 90 - 90目标至关重要。这项定性研究探讨了艾滋病毒阳性的客户的原因下，最大的抗逆转录病毒治疗测试和治疗实施研究在斯威士兰停止抗逆转录病毒治疗。从两家机构中有目的地选择在计划数据库中被确定为失访（LTFU）的客户，他们在Max ART研究的干预组下开始了ART。LTFU的定义是自上次预约之日起停止ART补充三个月或更长时间，并且不被归类为转出或死亡。在2017年7月至8月期间，与9名客户和1名治疗支持者进行了半结构化面对面访谈。所有访谈均以当地语言进行，并进行了录音、总结或转录，并翻译成英文进行专题分析。受访者将流动性描述为影响护理保留的一系列事件的第一步。它伴随着不稳定的就业、护理提供、与卫生工作者的互动、缺乏社会支持、预期的耻辱和与ART相关的副作用，包括饥饿的加剧。事件链涉及几个交叉的原因，这些原因一个接一个地发生，作为一系列连续和联系的事件，导致客户最终停止ART。逐步决策的个人账户揭示了多层次背景的影响和关键生活事件的重要性。客户放弃ART的原因是一系列复杂的、不可分割的事件，而不是一个单一的事件。流动往往是这一过程的第一步，通常是不稳定的经济和社会环境造成的。目前的卫生系统很难满足人们移动的生活的现实。干预措施应寻求增加医护人员对导致ART中断的事件链和客户面临的社会困境的理解。
Retention on antiretroviral therapy (ART) is critical for the successful adoption of the test and treat policy by sub‐Saharan African countries, and for realizing the United Nations programme on HIV and AIDS target of 90‐90‐90. This qualitative study explores HIV positive clients’ reasons for discontinuing ART under the Max ART test and treat implementation study in Swaziland. Clients identified as lost to follow‐up (LTFU) in the programme database, who had initiated ART under the intervention arm of the Max ART study, were purposively selected from two facilities. LTFU was defined as stopping ART refill for three months or longer from the date of last appointment, and not being classified as transferred out or deceased. Semi‐structured face‐to‐face interviews were conducted with nine clients and one treatment supporter between July and August 2017. All interviews were conducted in the local language, audio‐recorded, summarized or transcribed and translated to English for thematic analysis. Respondents described mobility as the first step in a chain of events that affected retention in care. It was entwined with precarious employment, care delivery, interactions with health workers, lack of social support, anticipated stigma and ART‐related side‐effects, including the exacerbation of hunger. The chains of events involved several intersecting reasons that occurred one after the other as a series of contiguous and linked events that led to clients’ eventual discontinuation of ART. The individual accounts of step‐by‐step decision‐making revealed the influence of multi‐layered contexts and the importance of critical life‐events. Clients’ reasons for abandoning ART are a complex, inextricably interwoven chain of events rather than a single occurrence. Mobility is often the first step in the process and commonly results from precarious economic and social circumstances. Currently the health system poorly caters to the reality of people's mobile lives. Interventions should seek to increase healthcare workers’ understanding of the chain of events leading up to discontinuation on ART and the social dilemmas that clients face.
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