"After all, we are all sick": multi-stakeholder understanding of stigma associated with integrated management of HIV, diabetes and hypertension at selected government clinics in Uganda.
"After all, we are all sick": multi-stakeholder understanding of stigma associated with integrated management of HIV, diabetes and hypertension at selected government clinics in Uganda.
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DOI：
10.1186/s12913-022-08959-3
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发表时间：
2023-01-09
影响因子：
2.8
通讯作者：
中科院分区：
文献类型：
--
作者：
综合护理越来越多地用于管理慢性病。在乌干达，已试行艾滋病毒、糖尿病和高血压综合护理，以充分利用便利和已建立的艾滋病毒保健提供结构的优势。这项定性研究旨在探讨艾滋病毒污名动态，同时调查多方利益相关者的看法和经验，提供和接受艾滋病毒，糖尿病和高血压综合管理在选定的政府诊所在乌干达中部。参与者是有目的地选择的。对患者、医疗保健提供者、临床研究人员、政策制定者和国际非政府组织（NGO）的代表进行了深入访谈。与社区成员和领导人进行了重点小组讨论。观察综合护理诊所的临床程序。使用Nvivo 12管理数据并按主题进行分析。三角调查结果显示，围绕艾滋病毒相关的耻辱不同的多利益攸关方的看法。综合护理减少了艾滋病毒、糖尿病、高血压患者就诊的频率，降低了相关的治疗费用，增加了患者和医疗保健提供者之间的人际关系，并提高了医疗保健提供者管理多种慢性病的能力。融合通过创造健康教育机会减少了耻辱感，这减轻了病人的恐惧，增强了他们登记和坚持治疗的决心。患者也有机会提供和接受心理社会支持，并得到医护人员的支持。这加强了病人与病人之间以及提供者与病人之间的关系，而这种关系是服务一体化和减少艾滋病毒污名化的基石。虽然这一模式大大减少了耻辱感，但它并没有消除艾滋病毒患者在服务水平上的挑战和社会歧视。该研究表明，在乌干达这样的低资源环境中，艾滋病毒，糖尿病和高血压护理的整合可以改善患者对多种慢性病的护理体验，综合诊所可以减少与艾滋病毒相关的耻辱感。 在线版本包含补充材料，可通过10.1186/s12913-022-08959-3获得。
Integrated care is increasingly used to manage chronic conditions. In Uganda, the integration of HIV, diabetes and hypertension care has been piloted, to leverage the advantages of well facilitated and established HIV health care provision structures. This qualitative study aimed to explore HIV stigma dynamics whilst investigating multi-stakeholder perceptions and experiences of providing and receiving integrated management of HIV, diabetes and hypertension at selected government clinics in Central Uganda. We adopted a qualitative-observational design. Participants were purposively selected. In-depth interviews were conducted with patients and with health care providers, clinical researchers, policy makers, and representatives from international nongovernmental organizations (NGOs). Focus group discussions were conducted with community members and leaders. Clinical procedures in the integrated care clinic were observed. Data were managed using Nvivo 12 and analyzed thematically. Triangulated findings revealed diverse multi-stakeholder perceptions around HIV related stigma. Integrated care reduced the frequency with which patients with combinations of HIV, diabetes, hypertension visited health facilities, reduced the associated treatment costs, increased interpersonal relationships among patients and healthcare providers, and increased the capacity of health care providers to manage multiple chronic conditions. Integration reduced stigma through creating opportunities for health education, which allayed patient fears and increased their resolve to enroll for and adhere to treatment. Patients also had an opportunity to offer and receive psycho-social support and coupled with the support they received from healthcare worker. This strengthened patient-patient and provider-patient relationships, which are building blocks of service integration and of HIV stigma reduction. Although the model significantly reduced stigma, it did not eradicate service level challenges and societal discrimination among HIV patients. The study reveals that, in a low resource setting like Uganda, integration of HIV, diabetes and hypertension care can improve patient experiences of care for multiple chronic conditions, and that integrated clinics may reduce HIV related stigma. The online version contains supplementary material available at 10.1186/s12913-022-08959-3.
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影响因子：
2.8
作者：
McCombe G;Murtagh S;Lazarus JV;Van Hout MC;Bachmann M;Jaffar S;Garrib A;Ramaiya K;Sewankambo NK;Mfinanga S;Cullen W
通讯作者：
Cullen W
DOI：
10.1097/qad.0000000000001887
发表时间：
2018-07-01
期刊：
AIDS (London, England)
影响因子：
--
作者：
Njuguna B;Vorkoper S;Patel P;Reid MJA;Vedanthan R;Pfaff C;Park PH;Fischer L;Laktabai J;Pastakia SD
通讯作者：
Pastakia SD
影响因子：
6
作者：
Sando, David;Kintu, Alexander;Verguet, Stephane
通讯作者：
Verguet, Stephane
影响因子：
8.1
作者：
Adeyemi O;Lyons M;Njim T;Okebe J;Birungi J;Nana K;Claude Mbanya J;Mfinanga S;Ramaiya K;Jaffar S;Garrib A
通讯作者：
Garrib A
影响因子：
3.7
作者：
Geng EH;Bwana MB;Kabakyenga J;Muyindike W;Emenyonu NI;Musinguzi N;Mugyenyi P;Martin JN;Bangsberg DR
通讯作者：
Bangsberg DR