Factors Affecting the Implementation of Electronic Antiretroviral Therapy Adherence Monitoring and Associated Interventions for Routine HIV Care in Uganda: Qualitative Study.
Factors Affecting the Implementation of Electronic Antiretroviral Therapy Adherence Monitoring and Associated Interventions for Routine HIV Care in Uganda: Qualitative Study.
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DOI：
10.2196/18038
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发表时间：
2020-09-10
影响因子：
7.4
通讯作者：
Asiimwe S
中科院分区：
文献类型：
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作者：
Haberer JE;Garrison L;Tumuhairwe JB;Baijuka R;Tindimwebwa E;Tinkamanyire J;Burns BF;Asiimwe S
高度、持续地坚持艾滋病毒抗逆转录病毒疗法(ART)对于实现病毒抑制至关重要，这反过来又会导致重要的个人健康益处和减少二次病毒传播。电子依从性监测器记录每个开口处的日期和时间戳，作为服药行为的代理。这些监测仪可以与干预措施(例如，数据告知的遵从性咨询、基于短信的遵从性支持和/或警报)相结合，并已被证明在多种情况下可以提高遵从性。然而，它们的使用在很大程度上局限于研究背景。这项研究的目标是使用实施研究综合框架(CFIR)来了解与在乌干达实施低成本电子依从性监测和相关干预措施以进行常规艾滋病毒临床护理相关的因素。我们对卫生保健管理人员、临床医生和ART客户进行了深入的定性访谈，讨论了对电子依从性监测仪和相关干预措施的特点和功能的好恶，它们对艾滋病毒护理的潜在影响，如何衡量它们的价值的建议，以及它们在常规护理中使用的建议。我们使用归纳的内容分析方法来理解参与者的观点，确定在这种环境下与技术实施最相关的CFIR方面。我们采访了34名卫生保健管理人员/临床医生和15名ART客户。参与者基本上认为监测仪和相关干预措施有利于支持坚持治疗，并通过有效的差异化护理改善临床结果。相关的外部因素包括健康的结构性决定因素、支持遵守的国际规范，以及需要仔细评估成本和收益的有限资金。在诊所内，坚持数据被认为可能改善咨询的质量，从而提高士气，以及提高护理提供的效率。现有的基础设施和护理支出以及适当培训的必要性也是值得注意的考虑因素。在个人层面上，对良好健康的渴望和受欢迎的坚持压力有利于监测仪的普及，尽管一些与会者担心客户没有按计划使用监测仪，以及贫困、耻辱和对隐私的需求的影响。最后，与会者认为，围绕实施进程的决定必须由卫生部和其他资助者作出，并将受到技术可持续性和使用该技术的目标人群的影响。整个卫生保健系统的协调对于实施将是重要的。低成本的电子依从性监测与数据通知咨询、基于短信的支持和/或警报相结合，有可能在乌干达的常规艾滋病毒护理中使用。成功实施的关键指标将包括它们对提供护理的效率和临床结果的影响，并仔细注意诸如耻辱和成本等因素。需要进一步的理论驱动的实施科学努力，将有前途的技术从研究转化为临床护理。ClinicalTrials.gov NCT03825952；https://clinicaltrials.gov/ct2/show/NCT03825952
High, sustained adherence to HIV antiretroviral therapy (ART) is critical for achieving viral suppression, which in turn leads to important individual health benefits and reduced secondary viral transmission. Electronic adherence monitors record a date-and-time stamp with each opening as a proxy for pill-taking behavior. These monitors can be combined with interventions (eg, data-informed adherence counseling, SMS-based adherence support, and/or alarms) and have been shown to improve adherence in multiple settings. Their use, however, has largely been limited to the research context. The goal of the research was to use the Consolidated Framework for Implementation Research (CFIR) to understand factors relevant for implementing a low-cost electronic adherence monitor and associated interventions for routine HIV clinical care in Uganda. We conducted in-depth qualitative interviews with health care administrators, clinicians, and ART clients about likes and dislikes of the features and functions of electronic adherence monitors and associated interventions, their potential to influence HIV care, suggestions on how to measure their value, and recommendations for their use in routine care. We used an inductive, content analysis approach to understand participant perspectives, identifying aspects of CFIR most relevant to technology implementation in this setting. We interviewed 34 health care administrators/clinicians and 15 ART clients. Participants largely saw the monitors and associated interventions as favorable and beneficial for supporting adherence and improving clinical outcomes through efficient, differentiated care. Relevant outside factors included structural determinants of health, international norms around supporting adherence, and limited funding that necessitates careful assessment of costs and benefits. Within the clinic, the adherence data were felt likely to improve the quality of counseling and thereby morale, as well as increase the efficiency of care delivery. Existing infrastructure and care expenditures and the need for proper training were other noted considerations. At the individual level, the desire for good health and a welcomed pressure to adhere favored uptake of the monitors, although some participants were concerned with clients not using the monitors as planned and the influence of poverty, stigma, and need for privacy. Finally, participants felt that decisions around the implementation process would have to come from the Ministry of Health and other funders and would be influenced by sustainability of the technology and the target population for its use. Coordination across the health care system would be important for implementation. Low-cost electronic adherence monitoring combined with data-informed counseling, SMS-based support, and/or alarms have potential for use in routine HIV care in Uganda. Key metrics of successful implementation will include their impact on efficiency of care delivery and clinical outcomes with careful attention paid to factors such as stigma and cost. Further theory-driven implementation science efforts will be needed to move promising technology from research into clinical care. ClinicalTrials.gov NCT03825952; https://clinicaltrials.gov/ct2/show/NCT03825952