Qualitative insights into implementation, processes, and outcomes of a randomized trial on peer support and HIV care engagement in Rakai, Uganda.
Qualitative insights into implementation, processes, and outcomes of a randomized trial on peer support and HIV care engagement in Rakai, Uganda.
复制标题
对乌干达Rakai的同伴支持和艾滋病毒护理参与的随机试验的实施，过程和结果的定性见解。
DOI：
10.1186/s12879-016-2156-0
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发表时间：
2017-01-10
影响因子：
3.7
通讯作者：
Chang LW
中科院分区：
文献类型：
--
作者：
Monroe A;Nakigozi G;Ddaaki W;Bazaale JM;Gray RH;Wawer MJ;Reynolds SJ;Kennedy CE;Chang LW
尚未开始抗逆转录病毒疗法的艾滋病毒感染者可以从参与护理和利用预防性干预措施中受益。以社区为基础的同伴支持可能是促进这些重要的艾滋病毒服务的有效办法。在进行了一项关于同伴支持对ART前结果的影响的随机试验后，我们进行了定性评估，以更好地了解试验实施，过程和结果。总体而言，75名参与者，包括试验参与者（客户），同行支持者和诊所工作人员，参加了41次深入访谈和6次焦点小组讨论。一个情境信息动机，行为技能模式的行为改变被用来开发半结构化的访谈和焦点小组指南。文字记录被编码和主题合成。我们发现，参与者的叙述与理论模型基本一致，表明同伴支持改善了信息，动机和行为技能，从而增加了对ART前护理的参与。客户描述了同伴支持者如何加强健康信息，并帮助他们更好地理解复杂的健康信息。同伴支持者还帮助客户浏览卫生系统，发展支持网络，并确定记住药物和诊所预约的策略。一些同伴支持者的角色超越了探访病人，成为客户与其家人、社区和卫生系统之间的桥梁。定性结果表明，合理的过程中，同行的支持，提高客户参与护理，复方新诺明的使用，和安全水容器的使用。确定的挑战包括围绕抗逆转录病毒疗法启动的信息不足，抗逆转录病毒疗法启动后缺乏护理连续性，罕见的违反保密性和结构性挑战。评价发现，各利益攸关方对同侪干预的看法基本上是积极的，并提供了宝贵的信息，以了解干预的吸收和可扩展性。研究结果还提出了几个方面的改进，为未来的实施前ART同行支持计划。 NCT01366690。2011年6月2日注册。
People living with human immunodeficiency virus (HIV) who have not yet initiated antiretroviral therapy (ART) can benefit from being engaged in care and utilizing preventive interventions. Community-based peer support may be an effective approach to promote these important HIV services. After conducting a randomized trial of the impact of peer support on pre-ART outcomes, we conducted a qualitative evaluation to better understand trial implementation, processes, and results. Overall, 75 participants, including trial participants (clients), peer supporters, and clinic staff, participated in 41 in-depth interviews and 6 focus group discussions. A situated Information Motivation, and Behavioral skills model of behavior change was used to develop semi-structured interview and focus group guides. Transcripts were coded and thematically synthesized. We found that participant narratives were generally consistent with the theoretical model, indicating that peer support improved information, motivation, and behavioral skills, leading to increased engagement in pre-ART care. Clients described how peer supporters reinforced health messages and helped them better understand complicated health information. Peer supporters also helped clients navigate the health system, develop support networks, and identify strategies for remembering medication and clinic appointments. Some peer supporters adopted roles beyond visiting patients, serving as a bridge between the client and his or her family, community, and health system. Qualitative results demonstrated plausible processes by which peer support improved client engagement in care, cotrimoxazole use, and safe water vessel use. Challenges identified included insufficient messaging surrounding ART initiation, lack of care continuity after ART initiation, rare breaches in confidentiality, and structural challenges. The evaluation found largely positive perceptions of the peer intervention across stakeholders and provided valuable information to inform uptake and scalability of the intervention. Study findings also suggest several areas for improvement for future implementation of pre-ART peer support programs. NCT01366690. Registered June 2, 2011.