Barriers to accessing antiretroviral therapy in Kisesa, Tanzania: A qualitative study of early rural referrals to the national program
Barriers to accessing antiretroviral therapy in Kisesa, Tanzania: A qualitative study of early rural referrals to the national program
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DOI：
10.1089/apc.2006.20.649
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发表时间：
2006-09-01
影响因子：
4.9
通讯作者：
Urassa, Mark
中科院分区：
文献类型：
--
作者：
Mshana, Gerry Hillary;Wamoyi, Joyce;Urassa, Mark
这项以社区为基础的定性研究在坦桑尼亚基塞萨农村地区进行，探讨了自我认定的艾滋病毒抗体阳性者对获得国家抗逆转录病毒方案的障碍的看法和经验。这项研究是围绕在当地引进艾滋病毒疗法进行的更广泛的业务研究的一部分，涉及与村民进行协商，并通过临床评估记录早期转诊的进展情况，如果符合条件，还包括进一步的培训和药品采购。数据收集包括与社区成员的16次参与性小组讨论和与寻求治疗者的18次深入访谈。虽然与会者欢迎抗逆转录病毒疗法，但他们担心交通和补充食品费用、转诊医院不友好和令人困惑的名声以及难以维持长期治疗会限制获得治疗。对耻辱的恐惧构成了所有关切，对联系那些不希望披露其身份或表示不愿按方案要求确定“治疗伙伴”的转诊者构成了挑战。为了减少后勤障碍，支付了运输费用，并为医院就诊提供了便利。参与者对资格测试表示满意，认为这一过程比预期的要容易。大多数人愿意加入一个支持小组，一些人改变了对披露的态度。然而，经历的和预期的歧视继续阻碍抗逆转录病毒疗法的广泛采用。虽然采取简单的措施来减少所认为的障碍，改善了最初获得治疗的机会，并有助于克服早期转诊中的焦虑，但普遍存在的耻辱感仍然是最可怕的障碍。鼓励成功的转介分享他们的积极经验，并为新生的社区动员做出贡献，可以开始解决这个看似棘手的问题。
This community-based, qualitative study conducted in rural Kisesa District, Tanzania, explores perceptions and experiences of barriers to accessing the national antiretroviral programme among self-identified HIV-positive persons. Part of wider operations research around local introduction of HIV therapy, the study involved consultation with villagers and documented early referrals' progress through clinical evaluation and, if eligible, further training and drug procurement. Data collection consisted of 16 participatory group discussions with community members and 18 in-depth interviews with treatment-seekers. Although participants welcomed antiretroviral therapy, they feared that transportation and supplementary food costs, the referral hospital's reputation for being unfriendly and confusing, and difficulties in sustaining long-term treatment would limit accessibility. Fear of stigma framed all concerns, posing challenges for contacting referrals who did not want their status disclosed or expressed reluctance to identify a "treatment buddy" as required by the programme. To mitigate logistical barriers, transportation costs were paid and hospital visits facilitated. Participants reported satisfaction with eligibility testing, finding the process easier than anticipated. Most were willing to join a support group and some changed attitudes toward disclosure. However, both experienced and anticipated discrimination continue to hinder widespread antiretroviral therapy ( ART) uptake. While simple measures to reduce perceived barriers improved initial access to treatment and helped overcome anxiety among early referrals, pervasive stigma remains the most formidable barrier. Encouraging successful referrals to share their positive experiences and contribute to nascent community mobililzation could start to address this seemingly intractable problem.