Engaging men in HIV programmes: a qualitative study of male engagement in community-based antiretroviral refill groups in Zimbabwe
Engaging men in HIV programmes: a qualitative study of male engagement in community-based antiretroviral refill groups in Zimbabwe
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DOI：
10.1002/jia2.25403
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发表时间：
2019-10-01
影响因子：
6
通讯作者：
Rabkin, Miriam
中科院分区：
文献类型：
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作者：
Mantell, Joanne E.;Masvawure, Tsitsi B.;Rabkin, Miriam
引入次优男性参与艾滋病毒方案是一项持久的挑战，导致艾滋病毒检测、预防和治疗服务覆盖率较低，并使男子的结果变得更糟。差异化服务提供模式，如同行领导的社区抗逆转录病毒再灌注组(CARGs)，提供了提高患者满意度、保留率和治疗结果的机会。我们进行了一项探索性的定性研究，以确定艾滋病毒阳性男性参与CAG的促进者和障碍，来自艾滋病毒护理接受者、社区成员、医疗工作者(HCW)、捐赠者和政策制定者的投入。方法2017年7月至10月，我们对147名成年HIV感染者进行了20次焦点小组讨论(FGD)，其中包括参加CARGs的男性和女性以及未参加CARGs的男性，并对政策制定者、捐赠者、卫生工作者和社区成员进行了46次关键线人访谈(KIIS)。FGDS和KIIS被记录、转录和翻译。采用不断比较的方法，对调查结果进行三角分析，并确定与津巴布韦农村地区男性参与CARGs有关的主题。结果CAG参与者、政策制定者、捐赠者、卫生工作者和社区成员注意到参与CAG的许多好处，包括便利性、效率、团结和相互心理社会支持。尽管那些熟悉CARGs的人报告说，这些小组减少了与艾滋病毒有关的耻辱，但对耻辱和隐私的担忧被认为是男性不参加的主要原因。男性入学的其他重要障碍包括缺乏对CARG的认识、对CARG如何运作的误解、几乎没有察觉到的好处以及在实施CARG方面缺乏灵活性。结论更有效的教育和提高认识运动、以社区为基础的反污名运动、更灵活的CARG设计，以及向CARG成员提供财政和/或实物支持，可以减少男性加入CARGs的许多障碍。男性还可能更喜欢基于设施和/或不需要团体参与的替代差异化服务交付模式。
Introduction Suboptimal male engagement in HIV programmes is a persistent challenge, leading to lower coverage of HIV testing, prevention and treatment services, and to worse outcomes for men. Differentiated service delivery models, such as peer-led community antiretroviral refill groups (CARGs), offer the opportunity to enhance patient satisfaction, retention and treatment outcomes. We conducted an exploratory qualitative study to identify facilitators and barriers to CARG participation by HIV-positive men, with inputs from recipients of HIV care, community members, healthcare workers (HCWs), donors and policymakers. Methods Between July and October 2017, we conducted 20 focus group discussions (FGDs) with 147 adults living with HIV, including men and women enrolled in CARGs and men not enrolled in CARGs, and 46 key informant interviews (KIIs) with policymakers, donors, HCWs and community members. FGDs and KIIs were recorded, transcribed and translated. A constant comparison approach was used to triangulate findings and identify themes related to male engagement in CARGs in rural Zimbabwe. Results CARG participants, policymakers, donors, HCWs, and community members noted many advantages to CARG participation, including convenience, efficiency, solidarity and mutual psychosocial support. Although those familiar with CARGs reported that these groups decreased HIV-related stigma, concerns about stigma and privacy were perceived to be the primary reason for men's non-participation. Other important barriers to male enrolment included lack of awareness of CARGs, misunderstanding of how CARGs operate, few perceived benefits and lack of flexibility in CARG implementation. Conclusions More effective educational and awareness campaigns, community-based anti-stigma campaigns, more flexible CARG designs, and provision of financial and/or in-kind support to CARG members could mitigate many of the barriers to male enrolment in CARGs. Men may also prefer alternative differentiated service delivery models that are facility-based and/or do not require group participation.