Assisted partner notification services for patients receiving HIV care and treatment in an HIV clinic in Nairobi, Kenya: a qualitative assessment of barriers and opportunities for scale-up
Assisted partner notification services for patients receiving HIV care and treatment in an HIV clinic in Nairobi, Kenya: a qualitative assessment of barriers and opportunities for scale-up
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DOI：
10.1002/jia2.25315
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发表时间：
2019-07-01
影响因子：
6
通讯作者：
Farquhar, Carey
中科院分区：
文献类型：
--
作者：
Monroe-Wise, Aliza;Mutiti, Peter Maingi;Farquhar, Carey
导言：确认艾滋病毒阳性个人日益被认为是艾滋病规划署90-90-90目标中最重要和最具挑战性的目标之一。协助伙伴通知服务包括向艾滋病毒阳性患者的伴侣追踪和提供艾滋病毒检测，向新诊断的艾滋病毒阳性患者提供有效和安全的服务。自愿APN现在是世界卫生组织艾滋病毒预防和护理指南的一部分。然而，与新诊断的人相比，已经在接受护理的已确定感染艾滋病毒的成年人对APN的摄取率显著低于新诊断的人。方法：我们于2016年4月至5月在内罗毕最大的公共HIV诊所进行了焦点小组讨论和深入访谈，以阐明在从事HIV护理的现有患者中提供APN的障碍和机会。参与者包括接受护理的艾滋病毒阳性成年人、他们的伴侣和医护人员(HCW)。定性数据分析采用扎根的理论方法。结果：APN的障碍主要分为三大类。对向伴侣披露信息的恐惧包括对关系影响、失去信任、指责和暴力的担忧。耻辱和歧视在医疗保健环境、教会和一般社会中都得到了描述。与会者描述了沟通方面的困难，包括文化障碍和教育方面的差异。对于几乎每一个障碍，都确定了一个潜在的解决方案，并出现了障碍-机会关系。机会包括利用夫妇检测中心帮助披露，重点关注感染的模棱两可的介绍，以及对卫生工作者和社区领袖的敏感性。结论：与新诊断的患者相比，已建立的HIV患者的APN与不同的障碍和机会有关，卫生工作者应建立自己的能力来支持这一人群的APN。考虑到伙伴通知的时机、关系的特点和知识不一致的持续时间等因素，迫切需要加强对不同情况和不同客户使用APN的培训和宣传。在艾滋病毒携带者人群中进行这种干预的总体成功可能取决于定制服务和关键信息，以满足患者的特定需求。
Introduction: Identifying HIV-positive individuals is increasingly recognized as one of the most important and most challenging of the UNAIDS 90-90-90 goals. Assisted partner notification services (aPNS) involves tracing and offering HIV testing to partners of HIV-positive individuals, and is effective and safe when provided to newly diagnosed HIV-positive patients. Voluntary aPNS is now part of the World Health Organization's guidelines for HIV prevention and care. However, uptake of aPNS is significantly lower among adults with established HIV infection already engaged in care compared to newly diagnosed individuals. We sought to describe barriers encountered and potential opportunities to providing aPNS to established patients living with HIV.Methods: We conducted focus group discussions and in-depth interviews at Nairobi's largest public HIV clinic in April to May 2016 to elucidate barriers to and opportunities for aPNS among established patients engaged in HIV care. Participants included HIV-positive adults in care, their partners, and healthcare workers (HCWs). Qualitative data analysis took a grounded theory approach.Results: Barriers to aPNS fell under three main categories. Fear of disclosure to partners included concerns over relationship repercussions, loss of trust, blame and violence. Stigma and discrimination were described in the healthcare setting, at church and in general society. Participants described difficulties approaching communication, including cultural barriers and differences in education. For almost every barrier a potential solution was also identified, and a barrier-opportunity relationship emerged. Opportunities included using couples testing centres to aid in disclosure, focusing on the ambiguous introduction of the infection, and sensitization of HCWs and community leaders.Conclusions: aPNS among established HIV patients is associated with different barriers and opportunities than aPNS among newly diagnosed patients, and HCWs should build their capacity to support aPNS in this population. There is a strong need for increased training and sensitization on the use of aPNS in different circumstances and for different clients, taking into consideration factors such as timing of partner notification, characteristics of the relationship and duration of knowledge discordance. The overall success of this intervention among populations living with HIV may rely on customization of services and key messages to meet the patients' specific needs.