"Hurdles on the path to 90-90-90 and beyond": Qualitative analysis of barriers to engagement in HIV care among individuals in rural East Africa in the context of test-and-treat.
"Hurdles on the path to 90-90-90 and beyond": Qualitative analysis of barriers to engagement in HIV care among individuals in rural East Africa in the context of test-and-treat.
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DOI：
10.1371/journal.pone.0202990
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Camlin CS
中科院分区：
文献类型：
--
作者：
Ayieko J;Brown L;Anthierens S;Van Rie A;Getahun M;Charlebois ED;Petersen ML;Clark TD;Kamya MR;Cohen CR;Bukusi EA;Havlir DV;Camlin CS
尽管取得了重大进展，但艾滋病毒护理层级的差距仍然很大：2015年，全球约有3670万艾滋病毒感染者，其中1190万人不知道自己的艾滋病毒感染状况，1270万人需要抗逆转录病毒治疗，1300万人没有得到病毒抑制。我们试图加深对护理级联的三个关键步骤中参与护理的障碍的理解，这些步骤旨在对实现旨在遏制艾滋病毒流行的联合国艾滋病规划署90-90-90目标产生最大影响。在东非农村感染艾滋病毒的成年人中进行了分析。在基线年（2013年7月- 2014年6月），通过对63名参与正在进行的测试和治疗试验（NCT01864683）的个体进行深度访谈，收集定性数据。录音被转录、翻译成英语，并使用Atlas进行编码。ti的软件。数据分析使用一个主题框架来解释护理参与的障碍，该框架借鉴了类似背景下的理论和先前的实证研究。观察到参与护理的多重障碍。艾滋病毒相关的耻辱在预期、内化和制定的耻辱维度上表现为拒绝和害怕披露，并在级联的多个步骤中影响护理参与的失误。贫困（缺乏食物和交通工具）、缺乏社会支持、工作干扰、先前的卫生服务不良经历、药物副作用和治疗疲劳也对抗逆转录病毒疗法的坚持和病毒抑制产生负面影响。性别差异也被观察到，工作上的干扰和拒绝对男性的影响比对女性的影响更大。参与艾滋病毒护理的多重障碍仍然普遍存在于撒哈拉以南农村地区，威胁着联合国艾滋病规划署90-90-90目标的实现。为了控制这一流行病，需要加快努力，消除污名。赋予患者经济权力、创新药物配方以及对患者更加敏感的卫生系统，可能有助于克服参与护理的障碍。
Despite substantial progress, gaps in the HIV care cascade remain large: globally, while about 36.7 million people were living with HIV in 2015, 11.9 million of these individuals did not know their HIV status, 12.7 million were in need of antiretroviral therapy (ART) and 13.0 million were not virally suppressed. We sought to deepen understanding of the barriers to care engagement at three critical steps of the care cascade proposed to make greatest impact for attaining the UNAIDS 90-90-90 targets aimed at shutting down the HIV epidemic. Analyses were conducted among HIV-infected adults in rural East Africa. Qualitative data were collected using in-depth interviews among 63 individuals participating in an ongoing test-and treat trial (NCT01864683) in its baseline year (July 2013-June 2014). Audio recordings were transcribed, translated into English, and coded using Atlas.ti software. Data were analyzed using a thematic framework for explaining barriers to care engagement that drew upon both theory and prior empirical research in similar settings. Multiple barriers to engagement in care were observed. HIV-related stigma across dimensions of anticipated, internalized and enacted stigma manifested in denial and fears of disclosure, and influenced lapses in care engagement across multiple steps in the cascade. Poverty (lack of food and transport), lack of social support, work interference, prior negative experiences with health services, drug side effects, and treatment fatigue also negatively affected ART adherence and viral suppression. Gender differences were observed, with work interference and denial disproportionately affecting men compared to women. Multiple barriers to HIV care engagement still pervade rural sub-Saharan settings threatening the realization of the UNAIDS 90-90-90 targets. To control the epidemic, efforts need to be accelerated to combat stigma. Patient economic empowerment, innovative drug formulations, as well as more patient-responsive health systems, may help overcome barriers to engagement in care.
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影响因子：
1.7
作者：
Grov C;Golub SA;Parsons JT;Brennan M;Karpiak SE
通讯作者：
Karpiak SE
影响因子：
4.9
作者：
Cunningham, Chinazo O.;Sohler, Nancy L.;Cabral, Howard D.
通讯作者：
Cabral, Howard D.
DOI：
10.1097/qad.0000000000000931
发表时间：
2016-01-28
期刊：
AIDS (London, England)
影响因子：
--
作者：
Camlin CS;Neilands TB;Odeny TA;Lyamuya R;Nakiwogga-Muwanga A;Diero L;Bwana M;Braitstein P;Somi G;Kambugu A;Bukusi EA;Glidden DV;Wools-Kaloustian KK;Wenger M;Geng EH;East Africa International Epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium
通讯作者：
East Africa International Epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium
在乌干达和肯尼亚农村的搜索试验中，使用简化的ART递送模型在成年人和患有高CD4+计数的儿童的病毒抑制率高。
影响因子：
6
作者：
Kwarisiima D;Kamya MR;Owaraganise A;Mwangwa F;Byonanebye DM;Ayieko J;Plenty A;Black D;Clark TD;Nzarubara B;Snyman K;Brown L;Bukusi E;Cohen CR;Geng EH;Charlebois ED;Ruel TD;Petersen ML;Havlir D;Jain V
通讯作者：
Jain V
影响因子：
4.9
作者：
Bradford, Judith B.
通讯作者：
Bradford, Judith B.