Uptake of community- versus clinic-based antiretroviral therapy dispensing in the Central Chronic Medication Dispensing and Distribution program in South Africa.
Uptake of community- versus clinic-based antiretroviral therapy dispensing in the Central Chronic Medication Dispensing and Distribution program in South Africa.
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DOI：
10.1002/jia2.25877
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发表时间：
2022-01
影响因子：
6
通讯作者：
Parker RA
中科院分区：
文献类型：
--
作者：
Bassett IV;Yan J;Govere S;Khumalo A;Ngobese N;Shazi Z;Nzuza M;Bunda BA;Wara NJ;Stuckwisch A;Zionts D;Dube N;Tshabalala S;Bogart LM;Parker RA
南非政府主导的中央慢性药物分配和分发（CCMDD）计划为艾滋病毒感染者提供了在社区或诊所为基础的拾取点收集抗逆转录病毒治疗的选择，旨在增加便利性和缓解诊所拥挤。为了了解艾滋病毒感染者使用CCMDD接送点的情况，我们评估了与CCMDD注册时采用社区与诊所接送点相关的因素。我们收集了2018年10月至2020年3月期间符合CCMDD临床合格标准（未妊娠、接受抗逆转录病毒治疗≥1年且病毒学抑制）的成人（≥18岁）的基线数据，作为夸祖鲁-纳塔尔7家公共诊所观察性队列的一部分。我们确定了与基于社区的接送点摄取相关的因素，并拟合了多变量logistic回归模型，包括年龄，性别，就业状况，自我感知的护理障碍，自我效能，HIV相关歧视以及CCMDD的感知益处和挑战。在1521名参与者中，67%为女性，中位年龄为36岁（IQR 30-44）。基于社区的接送点的使用与年轻年龄有关（aOR 1.18/10年下降，95% CI 1.05-1.33），每周工作≥40小时（aOR 1.42，95% CI 1.10-1.83）与失业、无自我感知的护理障碍相比（aOR 1.42，95% CI 1.09-1.86），自我效能量表评分介于36 - 39（aOR 1.44，95% CI 1.03-2.01）或40（aOR 1.91，95% CI 1.39-2.63）与10-35之间，评分越高表明自我效能越高。其他因素包括更方便的接送点位置（aOR 2.32，95% CI 1.77-3.04）或时间（aOR 5.09，95% CI 3.71-6.98）作为CCMDD的感知获益，以及错过采集日期后缺乏门诊随访作为CCMDD的感知挑战（aOR 4.37，95% CI 2.30-8.31）。社区接送的接受与年轻、全职工作、艾滋病毒感染者的系统性和结构性因素（没有自我感知的护理障碍和高自我效能）以及对CCMDD的看法（方便的接送点位置和时间，缺乏门诊随访）相关。应根据患者的年龄、就业情况、自我感知的护理障碍和自我效能，制定促进社区接送点使用的策略，以最大限度地发挥CCMDD在缓解充血诊所中的影响。
South Africa's government‐led Central Chronic Medication Dispensing and Distribution (CCMDD) program offers people living with HIV the option to collect antiretroviral therapy at their choice of community‐ or clinic‐based pick‐up points intended to increase convenience and decongest clinics. To understand CCMDD pick‐up point use among people living with HIV, we evaluated factors associated with uptake of a community‐ versus clinic‐based pick‐up point at CCMDD enrolment. We collected baseline data from October 2018 to March 2020 on adults (≥18 years) who met CCMDD clinical eligibility criteria (non‐pregnant, on antiretroviral therapy for ≥1 year and virologically suppressed) as part of an observational cohort in seven public clinics in KwaZulu‐Natal. We identified factors associated with community‐based pick‐up point uptake and fit a multivariable logistic regression model, including age, gender, employment status, self‐perceived barriers to care, self‐efficacy, HIV‐related discrimination, and perceived benefits and challenges of CCMDD. Among 1521 participants, 67% were females, with median age 36 years (IQR 30–44). Uptake of a community‐based pick‐up point was associated with younger age (aOR 1.18 per 10‐year decrease, 95% CI 1.05–1.33), being employed ≥40 hours per week (aOR 1.42, 95% CI 1.10–1.83) versus being unemployed, no self‐perceived barriers to care (aOR 1.42, 95% CI 1.09–1.86) and scoring between 36 and 39 (aOR 1.44, 95% CI 1.03–2.01) or 40 (aOR 1.91, 95% CI 1.39–2.63) versus 10–35 on the self‐efficacy scale, where higher scores indicate greater self‐efficacy. Additional factors included more convenient pick‐up point location (aOR 2.32, 95% CI 1.77–3.04) or hours (aOR 5.09, 95% CI 3.71–6.98) as perceived benefits of CCMDD, and lack of in‐clinic follow‐up after a missed collection date as a perceived challenge of CCMDD (aOR 4.37, 95% CI 2.30–8.31). Uptake of community‐based pick‐up was associated with younger age, full‐time employment, and systemic and structural factors of living with HIV (no self‐perceived barriers to care and high self‐efficacy), as well as perceptions of CCMDD (convenient pick‐up point location and hours, lack of in‐clinic follow‐up). Strategies to facilitate community‐based pick‐up point uptake should be tailored to patients’ age, employment, self‐perceived barriers to care and self‐efficacy to maximize the impact of CCMDD in decongesting clinics.
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DOI：
10.1097/qai.0000000000000553
发表时间：
2015-05-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Fox MP;Rosen S
通讯作者：
Rosen S
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：
4.5
作者：
Dos Santos MM;Kruger P;Mellors SE;Wolvaardt G;van der Ryst E
通讯作者：
van der Ryst E
影响因子：
4.4
作者：
Celestin K;Allorant A;Virgin M;Marinho E;Francois K;Honoré JG;White C;Valles JS;Perrin G;De Kerorguen N;Flowers J;Balan JG;Koama JBT;Barnhart S;Puttkammer N
通讯作者：
Puttkammer N
影响因子：
3
作者：
Cunningham, WE;Andersen, RM;Shapiro, MF
通讯作者：
Shapiro, MF