Feasibility and Acceptability of Health Communication Interventions Within a Combination Intervention Strategy for Improving Linkage and Retention in HIV Care in Mozambique.
Feasibility and Acceptability of Health Communication Interventions Within a Combination Intervention Strategy for Improving Linkage and Retention in HIV Care in Mozambique.
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DOI：
10.1097/qai.0000000000001208
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发表时间：
2017-01-01
期刊：
影响因子：
--
通讯作者：
Elul B
中科院分区：
文献类型：
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作者：
Sutton R;Lahuerta M;Abacassamo F;Ahoua L;Tomo M;Lamb MR;Elul B
在确保及时联系和保留艾滋病毒护理方面所面临的挑战已有详细记录。综合干预战略可以有效地改善艾滋病毒护理的连续性。关于一揽子干预措施中干预措施类型的可行性和可接受性的数据有限。Engage4Health研究评估了一项综合干预战略的有效性，以增加莫桑比克新诊断出感染艾滋病毒的成年人之间的联系和保留。该研究包括2种健康传播干预措施--修改抗逆转录病毒治疗前（pre-ART）咨询会议和SMS咨询服务的交付--和3种结构性干预措施--诊断后的即时CD4检测，加速ART启动和非现金经济激励。我们使用了一个过程评估框架来评估在有效性研究中，健康沟通与结构性干预的剂量传递--每个干预措施按计划传递的程度--和接受的剂量--参与者的可接受性，以了解相关的益处和挑战。数据来源包括研究记录、参与者访谈和临床数据。对于健康传播干预措施提供的剂量，98%的合格客户接受了ART前咨询，90%的参与者收到了至少一个短信提醒。对于结构性干预措施，74%的客户接受了CD4检测，53%的合格参与者在1个月内开始了抗逆转录病毒治疗。结构性干预措施面临的挑战包括设施层面的障碍、人员配置限制和机器故障。对于接受的剂量，参与者报告说，抗逆转录病毒治疗前咨询和CD4检测是最有用的联系干预措施，而经济激励措施对联系和保留最没用。研究结果表明，健康传播干预措施可以可行和可接受的结构性干预措施相结合，创造组合干预战略。
Challenges to ensuring timely linkage to and retention in HIV care are well documented. Combination intervention strategies can be effective in improving the HIV care continuum. Data on feasibility and acceptability of intervention types within intervention packages are limited. The Engage4Health study assessed the effectiveness of a combination intervention strategy to increase linkage and retention among adults newly diagnosed with HIV in Mozambique. The study included 2 health communication interventions—modified delivery of pre-antiretroviral therapy (pre-ART) counseling sessions and SMS reminders—and 3 structural interventions—point-of-care CD4 testing after diagnosis, accelerated ART initiation, and noncash financial incentives. We used a process evaluation framework to assess dose delivered—extent each intervention was delivered as planned—and dose received—participant acceptability—of health communication versus structural interventions in the effectiveness study to understand associated benefits and challenges. Data sources included study records, participant interviews, and clinical data. For dose delivered of health communication interventions, 98% of eligible clients received pre-ART counseling and 90% of participants received at least one SMS reminder. For structural interventions, 74% of clients received CD4 testing and 53% of eligible participants initiated ART within 1 month. Challenges for structural interventions included facility-level barriers, staffing limitations, and machine malfunctions. For dose received, participants reported pre-ART counseling and CD4 testing as the most useful interventions for linkage and financial incentives as the least useful for linkage and retention. Findings demonstrate that health communication interventions can be feasibly and acceptably integrated with structural interventions to create combination intervention strategies.