'My people perish for lack of knowledge': barriers and facilitators to integrated HIV and hypertension screening at the Kenyatta National Hospital, Nairobi, Kenya.
'My people perish for lack of knowledge': barriers and facilitators to integrated HIV and hypertension screening at the Kenyatta National Hospital, Nairobi, Kenya.
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艾滋病毒和心血管疾病是肯尼亚的两个主要死因，高血压是心血管疾病的主要危险因素，艾滋病毒感染是高血压的危险因素。我们定性评估了在肯雅塔国立医院进行艾滋病毒和高血压综合筛查的可行性。我们在2020年11月进行了两次焦点小组讨论（FGD）（女性FGD：n=7;男性FGD：n=8），以了解艾滋病毒检测服务（HTS）设施综合诊断和管理这两种情况的促进者，障碍和可行性。参与者是使用方便抽样选择的，没有配对。所有参与者都收到了HTS。所有女性客户都确认了高血压，而男性亲属则通过修改后的辅助合作伙伴服务模式进行了艾滋病毒和高血压筛查，其中训练有素的医疗保健提供者支持通知。成绩单独立编码，并通过协商一致的讨论，制定和修订的代码簿。采用专题内容分析法对数据进行了分析。诊断和管理的主要障碍包括公众对高血压风险因素的认识有限，对终身接受艾滋病毒治疗的人的治疗效果改善的认识有限，尽管有免费的艾滋病毒护理，但高血压护理费用高昂，以及医疗保健系统面临的挑战，特别是药物缺货。家庭和医疗保健一级强有力的支持系统促进了这两种疾病的护理和治疗。与会者建议通过个人层面的沟通和大众媒体宣传提高公众认识，分散艾滋病毒和高血压筛查服务，以及在提供艾滋病毒治疗服务的同时提供免费或补贴的高血压护理服务。大多数人认为，艾滋病毒和高血压综合服务模式是可行的，将改善医疗保健成果。以病人为中心的护理模式将艾滋病毒和高血压服务结合起来，为提供综合服务带来了希望。
HIV and cardiovascular disease (CVD) are the two main causes of death in Kenya with hypertension as CVD’s leading risk factor and HIV infection a risk factor for hypertension. We qualitatively evaluated the feasibility of integrated HIV and hypertension screening at Kenyatta National Hospital. We conducted two focus group discussions (FGDs) in November 2020 (female FGD: n=7; male FGD: n=8) to elicit facilitators, barriers and viability of integrated diagnosis and management of both conditions at HIV testing service (HTS) facilities. Participants were selected using convenience sampling and were not pair matched. All participants had received HTS. All female clients had confirmed hypertension, while male relatives had been contacted for HIV and hypertension screening through a modified assisted partner services model—where a trained healthcare provider supports notification. Transcripts were coded independently, and the codebook was developed and revised through consensus discussion. Data were analysed using thematic content analysis. Main barriers to diagnosis and management included limited public awareness of hypertension risk factors and on improved treatment outcomes for those on lifelong HIV treatment, high cost of hypertension care despite free HIV care and healthcare system challenges especially medication stockouts. Strong support systems at family and healthcare levels facilitated care and treatment for both conditions. Participants recommended improved public awareness through individual-level communication and mass media campaigns, decentralised screening services for both HIV and hypertension, and either free or subsidised hypertension care services delivered alongside HIV treatment services. Most felt that an integrated HIV and hypertension service model was viable and would improve healthcare outcomes. Patient-centred care models combining HIV and hypertension services hold promise for integrated service delivery.
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DOI：
10.1016/s2352-3018(16)30214-4
发表时间：
2017-02
期刊：
The lancet. HIV
影响因子：
--
作者：
Cherutich P;Golden MR;Wamuti B;Richardson BA;Ásbjörnsdóttir KH;Otieno FA;Ng'ang'a A;Mutiti PM;Macharia P;Sambai B;Dunbar M;Bukusi D;Farquhar C;aPS Study Group
通讯作者：
aPS Study Group
影响因子：
9.3
作者：
Quaife M;van Zandvoort K;Gimma A;Shah K;McCreesh N;Prem K;Barasa E;Mwanga D;Kangwana B;Pinchoff J;CMMID COVID-19 Working Group;Edmunds WJ;Jarvis CI;Austrian K
通讯作者：
Austrian K
DOI：
10.1080/09540121.2017.1344350
发表时间：
2018-01-01
影响因子：
1.7
作者：
Haldane, Victoria;Legido-Quigley, Helena;Perel, Pablo
通讯作者：
Perel, Pablo
影响因子：
4.5
作者：
Joshi, Mark David;Ayah, Richard;Mutai, Kenneth Kipyegon
通讯作者：
Mutai, Kenneth Kipyegon
影响因子：
3.7
作者：
Manavalan P;Minja L;Wanda L;Hertz JT;Thielman NM;Okeke NL;Mmbaga BT;Watt MH
通讯作者：
Watt MH