'They care rudely!': resourcing and relational health system factors that influence retention in care for people living with HIV in Zambia.
'They care rudely!': resourcing and relational health system factors that influence retention in care for people living with HIV in Zambia.
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DOI：
10.1136/bmjgh-2018-001007
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发表时间：
2018
影响因子：
8.1
通讯作者：
Topp SM
中科院分区：
文献类型：
--
作者：
Mwamba C;Sharma A;Mukamba N;Beres L;Geng E;Holmes CB;Sikazwe I;Topp SM
尽管可以获得免费的抗逆转录病毒治疗，许多艾滋病毒阳性的赞比亚人脱离艾滋病毒护理。我们试图了解赞比亚卫生系统的“硬件”（有形组件）和“软件”（工作实践和行为）如何影响决定脱离护理“失访”患者追踪一个更大的研究，他们目前的健康状况。我们有目的地选择了12个设施，来自4个省。深入访谈了69名患者，分为四类：从事艾滋病毒护理，脱离护理，转移到另一个设施和近亲，如果死亡。我们亦与158名非专业及专业医护人员进行了24次焦点小组讨论。这些数据是根据在每个设施进行的连续两天的观察进行三角测量的。我们使用归纳和演绎推理进行了迭代多层次分析。影响患者脱离的卫生系统“硬件”因素包括：保护隐私的基础设施不足;距离卫生设施较远，耗费患者时间和金钱;长期人手不足，增加了等待时间。卫生系统的“软件”因素与卫生保健工作者的工作实践和临床决策有关，包括延迟开放时间，文件管理不善，药物配给和访问时间表的可扩展性，增加等待时间，诊所访问次数和获得护理的机会。虽然患者认为HCW是“导师”和可信赖的信息来源，但许多人也将他们描述为粗鲁，迟缓，对细节和保密性不小心，并偏袒亲属。尽管如此，与以前报道的不同，许多患者更喜欢ART而不是替代治疗（例如，传统药物），因为其感知的疗效，免费可用性和伴随的临床监测。研究结果表明，健康系统的“硬件”和“软件”因素的动态效果的决定脱离。我们的研究结果表明，需要改进：物质资源和结构的艾滋病毒服务，护理和在职HCWs和管理培训和指导计划，以鼓励HCWs提供“以病人为中心”的护理和锻炼“灵活性”，以满足病人的不同需求和情况。
Despite access to free antiretroviral therapy (ART), many HIV-positive Zambians disengage from HIV care. We sought to understand how Zambian health system ‘hardware’ (tangible components) and ‘software’ (work practices and behaviour) influenced decisions to disengage from care among ‘lost-to-follow-up’ patients traced by a larger study on their current health status. We purposively selected 12 facilities, from 4 provinces. Indepth interviews were conducted with 69 patients across four categories: engaged in HIV care, disengaged from care, transferred to another facility and next of kin if deceased. We also conducted 24 focus group discussions with 158 lay and professional healthcare workers (HCWs). These data were triangulated against two consecutive days of observation conducted in each facility. We conducted iterative multilevel analysis using inductive and deductive reasoning. Health system ‘hardware’ factors influencing patients’ disengagement included inadequate infrastructure to protect privacy; distance to health facilities which costs patients time and money; and chronic understaffing which increased wait times. Health system ‘software’ factors related to HCWs’ work practices and clinical decisions, including delayed opening times, file mismanagement, drug rationing and inflexibility in visit schedules, increased wait times, number of clinic visits, and frustrated access to care. While patients considered HCWs as ‘mentors’ and trusted sources of information, many also described them as rude, tardy, careless with details and confidentiality, and favouring relatives. Nonetheless, unlike previously reported, many patients preferred ART over alternative treatment (eg, traditional medicine) for its perceived efficacy, cost-free availability and accompanying clinical monitoring. Findings demonstrate the dynamic effect of health system ‘hardware’ and ‘software’ factors on decisions to disengage. Our findings suggest a need for improved: physical resourcing and structuring of HIV services, preservice and inservice HCWs and management training and mentorship programmes to encourage HCWs to provide ‘patient-centered’ care and exercise ‘flexibility’ to meet patients’ varying needs and circumstances.
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影响因子：
4.5
作者：
Callaghan M;Ford N;Schneider H
通讯作者：
Schneider H
影响因子：
11.8
作者：
Geng, Elvin H.;Odeny, Thomas A.;Martin, Jeffrey
通讯作者：
Martin, Jeffrey
DOI：
10.1080/09540120701244943
发表时间：
2007-01-01
影响因子：
1.7
作者：
Hardon, A. P.;Akurut, D.;Laing, R.
通讯作者：
Laing, R.
影响因子：
4.5
作者：
Gupta N;Maliqi B;França A;Nyonator F;Pate MA;Sanders D;Belhadj H;Daelmans B
通讯作者：
Daelmans B
DOI：
10.1080/09540120701854634
发表时间：
2008-01-01
影响因子：
1.7
作者：
Grant, Elizabeth;Logie, Dorothy;Murray, Scott A.
通讯作者：
Murray, Scott A.