Adapting a community-based ART delivery model to the patients' needs: a mixed methods research in Tete, Mozambique
Adapting a community-based ART delivery model to the patients' needs: a mixed methods research in Tete, Mozambique
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DOI：
10.1186/1471-2458-14-364
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发表时间：
2014-04-15
影响因子：
4.5
通讯作者：
Van Damme, Wim
中科院分区：
文献类型：
--
作者：
Rasschaert, Freya;Decroo, Tom;Van Damme, Wim
背景：为了提高抗逆转录病毒治疗（ART）的保留率，将从慢性病护理中吸取的经验教训应用于艾滋病毒护理，为患者提供更多的慢性病护理责任。在莫桑比克太特，接受 ART 治疗稳定的患者通过社区 ART 小组 (CAG) 参与 ART 提供和同伴支持。本文分析了 CAG 模型在实施过程中的演变。方法：采用混合方法，对定性和定量结果进行三角测量。定性数据是通过半结构化焦点小组讨论和深度访谈收集的。应用归纳定性内容分析来浓缩和分类更广泛主题的数据。使用常规收集的数据计算健康结果、患者和群体的特征。我们应用“输入-过程-输出”路径来比较最初计划的活动与当前的发现。结果：从输入角度来看，辅导员被认为是组建和监督小组的关键。在此过程中，发现的主要修改是根据患者需求逐步调整日常 CAG 功能和资格标准。除了预期的产出（即节省成本和时间的效益以及改善治疗结果）之外，该模型还为成员提供了相互依从的支持和保护环境。患者积极参与诊所和社区的多项健康活动，提高了对艾滋病毒的认识，减少了耻辱感，改善了求医行为并提高了护理质量。结论：在过去四年中，CAG 模型的修改有助于增强患者的权能和更好的治疗结果。主要的悬而未决的问题之一是这种模式未来将如何发展。密切监测对于确保护理质量并以节省成本和时间的方式维持 CAG 模型“促进获得 ART 护理”的核心目标至关重要。
Background: To improve retention in antiretroviral therapy (ART), lessons learned from chronic disease care were applied to HIV care, providing more responsibilities to patients in the care of their chronic disease. In Tete - Mozambique, patients stable on ART participate in the ART provision and peer support through Community ART Groups (CAG). This article analyses the evolution of the CAG-model during its implementation process.Methods: A mixed method approach was used, triangulating qualitative and quantitative findings. The qualitative data were collected through semi-structured focus groups discussions and in-depth interviews. An inductive qualitative content analysis was applied to condense and categorise the data in broader themes. Health outcomes, patients' and groups' characteristics were calculated using routine collected data. We applied an `input - process - output' pathway to compare the initial planned activities with the current findings.Results: Input wise, the counsellors were considered key to form and monitor the groups. In the process, the main modifications found were the progressive adaptations of the daily CAG functioning and the eligibility criteria according to the patients' needs. Beside the anticipated outputs, i.e. cost and time saving benefits and improved treatment outcomes, the model offered a mutual adherence support and protective environment to the members. The active patient involvement in several health activities in the clinics and the community resulted in a better HIV awareness, decreased stigma, improved health seeking behaviour and better quality of care.Conclusions: Over the past four years, the modifications in the CAG-model contributed to a patient empowerment and better treatment outcomes. One of the main outstanding questions is how this model will evolve in the future. Close monitoring is essential to ensure quality of care and to maintain the core objective of the CAG-model `facilitating access to ART care' in a cost and time saving manner.