"It's about my life": facilitators of and barriers to isoniazid preventive therapy completion among people living with HIV in rural South Africa
"It's about my life": facilitators of and barriers to isoniazid preventive therapy completion among people living with HIV in rural South Africa
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DOI：
10.1080/09540121.2017.1283390
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发表时间：
2017-01-01
影响因子：
1.7
通讯作者：
Shenoi, Sheela V.
中科院分区：
文献类型：
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作者：
Jacobson, Karen B.;Niccolai, Linda;Shenoi, Sheela V.
尽管最近在南非推出了异烟肼预防治疗（IPT）来预防艾滋病毒感染者的结核病，但坚持率和完成率都很低。为了探讨南非夸祖鲁-纳塔尔农村完成IPT的障碍，我们对30名已完成或未完成IPT的HIV患者进行了个体半结构化访谈。访谈记录按照定性分析的框架法进行分析。促进者的IPT完成包括结核病和IPT的知识，接受一个人的艾滋病毒诊断，将IPT视为类似于抗逆转录病毒治疗，在社区和诊所的社会支持，在医疗保健系统的信任，并希望保持健康。障碍包括对IPT在没有症状的情况下的预防作用的误解，效率低下的卫生服务提供，与卫生保健工作者的有效沟通，到诊所的交通和工资损失的经济负担，以及竞争的优先事项。与艾滋病毒相关的耻辱感并没有被确定为完成IPT的重大障碍，参与者对他们管理耻辱感的能力充满信心，例如假装他们的药物是用于无关的疾病。完成者比违约者更愿意与医护人员沟通。促进成功完成IPT的努力必须包括为个别患者提供适当的咨询和教育，并解决医疗保健系统中的效率低下问题，以最大限度地减少患者的经济和后勤负担。这些患者水平和结构的变化是必要的，为IPT成功地减少结核病发病率在这个资源有限的设置。
Despite the recent rollout of Isoniazid Preventive Therapy (IPT) to prevent TB in people living with HIV in South Africa, adherence and completion rates are low. To explore barriers to IPT completion in rural KwaZulu-Natal, South Africa, we conducted individual semi-structured interviews among 30 HIV patients who had completed or defaulted IPT. Interview transcripts were analyzed according to the framework method of qualitative analysis. Facilitators of IPT completion included knowledge of TB and IPT, accepting one's HIV diagnosis, viewing IPT as similar to antiretroviral therapy, having social support in the community and the clinic, trust in the healthcare system, and desire for health preservation. Barriers included misunderstanding of IPT's preventive role in the absence of symptoms, inefficient health service delivery, ineffective communication with healthcare workers, financial burden of transport to clinic and lost wages, and competing priorities. HIV-related stigma was not identified as a significant barrier to IPT completion, and participants felt confident in their ability to manage stigma, for example by pretending their medications were for unrelated conditions. Completers were more comfortable communicating with health care workers than were defaulters. Efforts to facilitate successful IPT completion must include appropriate counseling and education for individual patients and addressing inefficiencies within the health care system in order to minimize patients' financial and logistical burden. These patient-level and structural changes are necessary for IPT to successfully reduce TB incidence in this resource-limited setting.