Factors affecting linkage to HIV care and ART initiation following referral for ART by a mobile health clinic in South Africa: evidence from a multimethod study
Factors affecting linkage to HIV care and ART initiation following referral for ART by a mobile health clinic in South Africa: evidence from a multimethod study
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DOI：
10.1007/s10865-018-0005-x
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发表时间：
2019-10-01
影响因子：
3.1
通讯作者：
Lurie, Mark N.
中科院分区：
文献类型：
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作者：
Maughan-Brown, Brendan;Harrison, Abigail;Lurie, Mark N.
与流动诊所提供的护理之间的联系往往很差，也没有得到充分的了解。这项多方法研究评估了开普敦一家流动诊所转介抗逆转录病毒疗法(ART)后护理和抗逆转录病毒疗法(ART)吸收的联系(2015/2016)。临床记录数据(N=86)表明，67%的患者与护理有关(即，去过诊所)，42%的患者在3个月内开始接受抗逆转录病毒治疗。与护理的关联与艾滋病毒状况披露意向(AOR：2.99，95%CI 1.13-7.91)和治疗准备情况(AOR：2.97，95%CI 1.05-8.34)正相关；与健康(AOR：0.35，95%CI 0.13-0.99)、每周饮酒(AOR：0.35，95%CI 0.12-0.98)和内在化污名(AOR：0.32，95%CI 0.11-0.91)负相关。在关联之后，感知到的污名对ART启动产生负面影响。深度访谈(N=41)阐明了对抗逆转录病毒治疗副作用、艾滋病毒状态否认和食品不安全作为抗逆转录病毒治疗启动障碍的恐惧；而意识到抗逆转录病毒治疗的积极影响、后续电话咨询、家庭责任和保持健康以避免非自愿披露是激励因素。结果表明，在流动诊所艾滋病毒检测服务之后，需要一系列干预措施来鼓励快速启动抗逆转录病毒治疗。
Linkage to care from mobile clinics is often poor and inadequately understood. This multimethod study assessed linkage to care and antiretroviral therapy (ART) uptake following ART-referral by a mobile clinic in Cape Town (2015/2016). Clinic record data (N = 86) indicated that 67% linked to care (i.e., attended a clinic) and 42% initiated ART within 3 months. Linkage to care was positively associated with HIV-status disclosure intentions (aOR: 2.99, 95% CI 1.13-7.91), and treatment readiness (aOR: 2.97, 95% CI 1.05-8.34); and negatively with good health (aOR: 0.35, 95% CI 0.13-0.99), weekly alcohol consumption (aOR: 0.35, 95% CI 0.12-0.98), and internalised stigma (aOR: 0.32, 95% CI 0.11-0.91). Following linkage, perceived stigma negatively affected ART-initiation. In-depth interviews (N = 41) elucidated fears about ART side-effects, HIV-status denial, and food insecurity as barriers to ART initiation; while awareness of positive ART-effects, follow-up telephone counselling, familial responsibilities, and maintaining health to avoid involuntary disclosure were motivating factors. Results indicate that an array of interventions are required to encourage rapid ART-initiation following mobile clinic HIV-testing services.