Health provider perspectives on the implementation of the same-day-ART initiation policy in the Gauteng province of South Africa.
Health provider perspectives on the implementation of the same-day-ART initiation policy in the Gauteng province of South Africa.
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DOI：
10.1186/s12961-020-00673-y
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发表时间：
2021-01-06
影响因子：
4
通讯作者：
Fox MP
中科院分区：
文献类型：
--
作者：
Onoya D;Mokhele I;Sineke T;Mngoma B;Moolla A;Vujovic M;Bor J;Langa J;Fox MP
2016年9月，南非开始实施普遍检测和治疗（UTT）政策，希望到2020年实现联合国艾滋病规划署的90-90-90目标。南非国家卫生部提供了进一步的指令，要求在2017年9月艾滋病毒诊断当天启动抗逆转录病毒治疗（ART）。我们进行了一项定性研究，以确定实施UTT的进展情况，并检查医疗服务提供者对实施当天启动（SDI）政策的看法，政策改变后六个月。2017年10月至12月，我们对豪登省五家初级卫生诊所的三名专业护士和四名艾滋病毒非专业顾问进行了深入访谈。2018年9月，我们还与来自10家诊所的10名专业护士/诊所经理进行了焦点小组讨论。访谈和焦点小组讨论了UTT和SDI政策的采用和实施情况。访谈以英语、塞尔维亚语或祖鲁语进行，并经参与者同意进行录音。录音经过逐字转录，翻译成英文，并使用NVivo 11进行专题分析。数据表明，不一致的设施和辅导员和护理提供者的角度之间的不一致的SDI政策的实施。虽然护士强调了早期ART启动的临床效益，他们表示担心，立即ART可能是压倒性的一些患者，谁可能是没有准备好，并可能脱离护理后不久，最初接受ART。因此，SDI的实施是缓慢的，由于有限的患者需求，供应商的矛盾心理的政策实施，以及基础设施和人力资源的挑战。评估患者准备程度的过程由各设施的卫生提供者定义不佳，不一致且依赖顾问。提供者也不清楚如何确保推迟治疗的病人返回接受持续的咨询。我们的研究结果突出了实现ART启动目标的重要差距，并表明需要进一步与医疗保健提供者围绕实施当天ART启动，特别是在基础设施/能力需求和管理患者在艾滋病毒诊断当天终身ART的准备方面。此外，有必要在卫生保健环境和媒体传播中更好地促进SDI的提供，以增加患者对早期和终身ART的需求。
In September 2016, South Africa (SA) began implementing the universal-test-and-treat (UTT) policy in hopes of attaining the UNAIDS 90-90-90 targets by 2020. The SA National Department of Health provided a further directive to initiate antiretroviral therapy (ART) on the day of HIV diagnosis in September 2017. We conducted a qualitative study to determine the progress in implementing UTT and examine health providers' perspectives on the implementation of the same-day initiation (SDI) policy, six months after the policy change. We conducted in-depth interviews with three professional nurses, and four HIV lay counsellors of five primary health clinics in the Gauteng province, between October and December 2017. In September 2018, we also conducted a focus group discussion with ten professional nurses/clinic managers from ten clinic facilities. The interviews and focus groups covered the adoption and implementation of UTT and SDI policies. Interviews were conducted in English, Sotho or Zulu and audio-recorded with participant consent. Audio-recordings were transcribed verbatim, translated to English and analysed thematically using NVivo 11. The data indicates inconsistencies across facilities and incongruities between counsellor and nursing provider perspectives regarding the SDI policy implementation. While nurses highlighted the clinical benefits of early ART initiation, they expressed concerns that immediate ART may be overwhelming for some patients, who may be unprepared and likely to disengage from care soon after the initial acceptance of ART. Accordingly, the SDI implementation was slow due to limited patient demand, provider ambivalence to the policy implementations, as well as challenges with infrastructure and human resources. The process for assessing patient readiness was poorly defined by health providers across facilities, inconsistent and counsellor dependent. Providers were also unclear on how to ensure that patients who defer treatment return for ongoing counselling. Our results highlight important gaps in the drive to achieve the ART initiation target and demonstrate the need for further engagement with health care providers around the implementation of same-day ART initiation, particularly with regards to infrastructural/capacity needs and the management of patient readiness for lifelong ART on the day of HIV diagnosis. Additionally, there is a need for improved promotion of the SDI provision both in health care settings and in media communications to increase patient demand for early and lifelong ART.
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DOI：
10.1111/tmi.12460
发表时间：
2015-04
期刊：
Tropical medicine & international health : TM & IH
影响因子：
--
作者：
Duncombe C;Rosenblum S;Hellmann N;Holmes C;Wilkinson L;Biot M;Bygrave H;Hoos D;Garnett G
通讯作者：
Garnett G
DOI：
10.1056/nejmoa1600693
发表时间：
2016-09-01
期刊：
The New England journal of medicine
影响因子：
--
作者：
Cohen MS;Chen YQ;McCauley M;Gamble T;Hosseinipour MC;Kumarasamy N;Hakim JG;Kumwenda J;Grinsztejn B;Pilotto JH;Godbole SV;Chariyalertsak S;Santos BR;Mayer KH;Hoffman IF;Eshleman SH;Piwowar-Manning E;Cottle L;Zhang XC;Makhema J;Mills LA;Panchia R;Faesen S;Eron J;Gallant J;Havlir D;Swindells S;Elharrar V;Burns D;Taha TE;Nielsen-Saines K;Celentano DD;Essex M;Hudelson SE;Redd AD;Fleming TR;HPTN 052 Study Team
通讯作者：
HPTN 052 Study Team
影响因子：
3.8
作者：
Ford, Nathan;Migone, Chantal;Shubber, Zara
通讯作者：
Shubber, Zara
影响因子：
1.7
作者：
Boyer S;Iwuji C;Gosset A;Protopopescu C;Okesola N;Plazy M;Spire B;Orne-Gliemann J;McGrath N;Pillay D;Dabis F;Larmarange J;ANRS 12249 TasP study group
通讯作者：
ANRS 12249 TasP study group
影响因子：
3.8
作者：
Enriquez, M;Lackey, NR;McKinsey, DS
通讯作者：
McKinsey, DS