Inadequate pre-antiretroviral care, stock-out of antiretroviral drugs and stigma: Policy challenges/bottlenecks to the new WHO recommendations for earlier initiation of antiretroviral therapy (CD < 350 cells/μL) in eastern Uganda
Inadequate pre-antiretroviral care, stock-out of antiretroviral drugs and stigma: Policy challenges/bottlenecks to the new WHO recommendations for earlier initiation of antiretroviral therapy (CD < 350 cells/μL) in eastern Uganda
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DOI：
10.1016/j.healthpol.2010.06.003
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发表时间：
2010-10-01
期刊：
影响因子：
3.3
通讯作者：
Pariyo, George
中科院分区：
文献类型：
--
作者：
Muhamadi, Lubega;Nsabagasani, Xavier;Pariyo, George
目的：本研究从乌干达东部的客户/看护人的角度探讨了已知艾滋病毒阳性者在护理中延迟开始抗逆转录病毒治疗的原因，在乌干达东部，抗逆转录病毒治疗的认识可能很高，但艾滋病相关的死亡率是延迟开始抗逆转录病毒治疗的常见功能。在伊冈，乌干达我们对开始抗逆转录病毒治疗的患者进行了深入访谈，这些患者的抗逆转录病毒治疗水平为50-200个CD 4细胞/μ L，而那些开始抗逆转录病毒治疗的时间很晚，CD 4 < 50个细胞/μ L。焦点小组的讨论也进行了与照顾者的客户ART. Content分析进行，以确定经常性的themes.Results：抗逆转录病毒药物缺货，抗逆转录病毒治疗前的护理不足，缺乏工作人员的保密性是系统的障碍，及时启动ART。弱的社会支持和普遍存在的耻辱和误解ARVs作为药物旨在杀死，导致癌症，不孕不育或阳痿是其他重要factors.Conclusion：如果新的世界卫生组织的建议（开始抗逆转录病毒治疗在CD 4 350细胞/亩L）应该是可行的，PLHIV/社区需要通过当地媒体和当局的宣传，定期的前ARV护理的重要性。还必须改善抗逆转录病毒药物供应链和工作人员对客户保密的态度，以鼓励及时启动抗逆转录病毒治疗。艾滋病毒感染者/社区应提高对药品包装标签以及抗逆转录病毒药物的使用和重要性的认识。必须通过公共信息建立更强有力的社会支持结构，打击污名化，提高对艾滋病毒感染者的接受程度，并鼓励及时开始抗逆转录病毒治疗。(C)2010爱思唯尔爱尔兰有限公司版权所有。
Objective: This study explores reasons for late ART initiation among known HIV positive persons in care from a client/caretaker perspective in eastern Ugandan where ART awareness is presumably high yet AIDS related mortality is a common function of late initiation of ARVs.Methods: In Igangs, Uganda we conducted in-depth interviews with clients who started ART at 50-200 CD4 cells/mu L and those initiated very late at CD4 < 50 cells/mu L. Focus-group discussions were also conducted with caretakers of clients on ART. Content analysis was performed to identify recurrent themes.Results: ARV stock-outs, inadequate pre-antiretroviral care and lack of staff confidentiality were system barriers to timely ART initiation. Weak social support and prevailing stigma and misconceptions about ARVs as drugs designed to kill, cause cancer, infertility or impotence were other important factors.Conclusion: If the new WHO recommendations (start ART at CD4 350 cells/mu L) should be feasible, PLHIV/communities need sensitization about the importance of regular pre-ARV care through the local media and authorities. The ARV supply chain and staff attitudes towards client confidentiality must also be improved in order to encourage timely ART initiation. PLHIV/communities should be sensitization about drug package labeling and the use and importance of ARVs. Stronger social support structures must be created through public messages that fight stigma, enhance acceptance of PLHIV and encourage timely ART initiation. (C) 2010 Elsevier Ireland Ltd. All rights reserved.