Availability and experiences of differentiated antiretroviral therapy delivery at HIV care facilities in rural Zimbabwe: a mixed-method study.
Availability and experiences of differentiated antiretroviral therapy delivery at HIV care facilities in rural Zimbabwe: a mixed-method study.
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DOI：
10.1002/jia2.25944
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发表时间：
2022-08
影响因子：
6
通讯作者：
Ballif, Marie
中科院分区：
文献类型：
--
作者：
Christ, Benedikt;van Dijk, Janneke H.;Nyandoro, Talent Y.;Reichmuth, Martina L.;Kunzekwenyika, Cordelia;Chammartin, Frederique;Egger, Matthias;Wringe, Alison;Ballif, Marie
津巴布韦在2015年采取了有区别的艾滋病毒护理政策，以促进以客户为中心的护理并减轻卫生设施的压力。我们调查了政策实施后津巴布韦农村地区差异化抗逆转录病毒治疗（ART）提供的可得性、经验和看法。我们在津巴布韦一个农村地区的所有26个提供艾滋病毒护理的机构中进行了一项横断面混合方法研究。我们收集了来自31个医疗保健提供者和378个通过常规护理或差异化ART提供模式获得ART的客户的定量数据和访问时间。我们在医疗保健提供者中进行了26次半结构化访谈，并在客户中进行了7次焦点小组讨论（fgd），以了解他们对抗逆转录病毒治疗的看法和经验。数据于2019年收集，并于2021年进行了一次后续FGD。我们用归纳编码对转录本进行了主题分析，以确定新出现的主题。20家机构（77%）提供至少一种差异化的ART交付模式，包括社区ART补充小组（carg； 13家机构，50%）、快速补充（8.31%）、家庭补充（6.23%）或俱乐部补充（1.4%）。13家（50%）仅提供一种型号。中位随访时间为28分钟（四分位间距[IQR]: 16-62）。快速通道的参与者就诊时间最短（18分钟，IQR: 11-24）。保密和披露艾滋病毒状况、长途旅行、旅行费用和等待时间是影响客户对有区别地提供抗逆转录病毒治疗的看法的主要问题。快速补充被认为是客户的首选模式，因为其有限的非自愿披露和效率。相比之下，以团体和社区为基础的补充模式减少了旅行成本，但被认为与非自愿披露艾滋病毒状况有关，这可能会使客户气馁。在提供基于设施的分组模型（如carg）时，医疗保健提供者也经历了额外的工作量。在这种农村环境中，差异化的ART提供模式广泛可用，但大多数设施没有提供模式选择，以满足客户的不同偏好。少数提供快速续杯，尽管这种模式经常被认为是可取的。保密、差旅费和客户等待时间是规划和推出差异化艾滋病毒护理时需要考虑的关键因素。
Zimbabwe adopted differentiated HIV care policies in 2015 to promote client‐centred care and relieve strain on health facilities. We examined the availability, experiences and perceptions of differentiated antiretroviral therapy (ART) delivery in rural Zimbabwe following the policy adoption. We undertook a cross‐sectional mixed methods study in all the 26 facilities providing HIV care in a rural district in Zimbabwe. We collected quantitative data about ART delivery and visit durations from 31 healthcare providers and a purposive stratified sample of 378 clients obtaining ART either through routine care or differentiated ART delivery models. We performed 26 semi‐structured interviews among healthcare providers and seven focus group discussions (FGDs) among clients to elicit their perceptions and experiences of ART delivery. Data were collected in 2019, with one follow‐up FGD in 2021. We analysed the transcripts thematically, with inductive coding, to identify emerging themes. Twenty facilities (77%) offered at least one differentiated ART delivery models, including community ART refill groups (CARGs; 13 facilities, 50%), fast‐track refill (8, 31%), family refill (6, 23%) or club refill (1, 4%). Thirteen facilities (50%) offered only one model. The median visit duration was 28 minutes (interquartile range [IQR]: 16–62). Participants in fast‐track had the shortest visit durations (18 minutes, IQR: 11–24). Confidentiality and disclosure of HIV status, travelling long distances, travel costs and waiting times were the main issues influencing clients’ views on differentiated ART delivery. Fast‐track refill was perceived as the preferred model of clients for its limited involuntary disclosure and efficiency. In contrast, group‐ and community‐based refill models reduced travel costs but were felt to be associated with involuntary disclosure of HIV status, which could discourage clients. Healthcare providers also experienced an additional workload when offering facility‐based group models, such as CARGs. Differentiated ART delivery models were widely available in this rural setting, but most facilities did not offer a choice of models to address clients’ diverse preferences. A minority offered fast‐track refills, although this model was often mentioned as desirable. Confidentiality, travel expenses and client waiting times are key elements to consider when planning and rolling out differentiated HIV care.
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DOI：
10.1111/tmi.12460
发表时间：
2015-04
期刊：
Tropical medicine & international health : TM & IH
影响因子：
--
作者：
Duncombe C;Rosenblum S;Hellmann N;Holmes C;Wilkinson L;Biot M;Bygrave H;Hoos D;Garnett G
通讯作者：
Garnett G
影响因子：
3.3
作者：
Bango, Funeka;Ashmore, John;Cleary, Susan
通讯作者：
Cleary, Susan
影响因子：
6
作者：
Long L;Kuchukhidze S;Pascoe S;Nichols BE;Fox MP;Cele R;Govathson C;Huber AN;Flynn D;Rosen S
通讯作者：
Rosen S
影响因子：
3.7
作者：
Gils, Tinne;Bossard, Claire;Ellman, Tom
通讯作者：
Ellman, Tom
影响因子：
6
作者：
Mantell, Joanne E.;Masvawure, Tsitsi B.;Rabkin, Miriam
通讯作者：
Rabkin, Miriam