Are integrated HIV services less stigmatizing than stand-alone models of care? A comparative case study from Swaziland.
Are integrated HIV services less stigmatizing than stand-alone models of care? A comparative case study from Swaziland.
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DOI：
10.7448/ias.16.1.17981
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发表时间：
2013-01-11
影响因子：
6
通讯作者：
Integra Initiative
中科院分区：
文献类型：
--
作者：
Church K;Wringe A;Fakudze P;Kikuvi J;Simelane D;Mayhew SH;Integra Initiative
将艾滋病毒与初级保健服务相结合，通过在与艾滋病毒无关的环境中提供护理，有可能减少与艾滋病毒有关的耻辱感。本研究旨在探讨整合照护与感受污名的关系。研究设计是一个比较案例研究的四种模式的艾滋病毒护理在斯威士兰，范围从完全整合到完全独立的艾滋病毒护理。一项退出调查（N=602）测量了不同护理模式下的耻辱感差异;使用多变量logistic回归分析了主要结局“通过门诊就诊对艾滋病毒状态暴露的感知”。深入访谈（N=22）探讨是否以及如何衡量差异的耻辱的经验与服务整合。有显着差异，在感知状态暴露的护理模式。在对研究中心之间的潜在混杂因素进行调整后，部分整合研究中心和部分独立研究中心的受试者比完全独立研究中心的受试者有更大的感知状态暴露几率（分别为aOR 3.33，95% CI 1.98-5.60; aOR 11.84，95% CI 6.89-20.36）。完全独立的诊所和完全集成的诊所之间没有区别。定性数据表明，许多客户在艾滋病毒的唯一网站感到更大的保密性，知道他们周围的人是积极的，并获得支持，从其他艾滋病毒护理客户。通过各种方式，甚至在独立的地点，通过分开的艾滋病毒检测和治疗等候区，以及仔细的诊所和房间标签，保持了保密。护理模式和耻辱感之间的关系是复杂的，在独立的网站耻辱感较高的假设并不成立，在这个高患病率的设置。决策者应确保服务一体化不会增加耻辱感，特别是在部分一体化的护理模式中。
Integrating HIV with primary health services has the potential to reduce HIV-related stigma through delivering care in settings disassociated with HIV. This study investigated the relationship between integrated care and felt stigma. The study design was a comparative case study of four models of HIV care in Swaziland, ranging from fully integrated to fully stand-alone HIV care. An exit survey (N=602) measured differences in felt stigma across model of care; the primary outcome “perception of HIV status exposure through clinic attendance” was analyzed using multivariable logistic regression. In-depth interviews (N=22) explored whether and how measured differences in stigma experiences were related to service integration. There were significant differences in perceived status exposure across models of care. After adjustment for potential confounding between sites, those at a partially integrated site and a partially stand-alone site had greater odds of perceived status exposure than those at the fully stand-alone site (aOR 3.33, 95% CI 1.98–5.60; and aOR 11.84, 95% CI 6.89–20.36, respectively). There was no difference between the fully stand-alone and the fully integrated clinic. Qualitative data suggested that many clients at HIV-only sites felt greater confidentiality knowing that those around them were positive, and support was gained from other HIV care clients. Confidentiality was maintained in various ways, even in stand-alone sites, through separate waiting areas for HIV testing and HIV treatment, and careful clinic and room labelling. The relationship between model of care and stigma was complex, and the hypothesis that stigma is higher at stand-alone sites did not hold true in this high prevalence setting. Policy-makers should ensure that service integration does not increase stigma, in particular within partially integrated models of care.