Wasti Sharada Prasad, Simkhada P, Teijlingen E R
Department of Public Health, University of Aberdeen, Scotland, UK.
Kathmandu Univ Med J (KUMJ). 2009 Jul-Sep;7(27):306-14. doi: 10.3126/kumj.v7i3.2743.
Antiretroviral (ARV) drugs have become the cornerstone of HIV (Human Immunodeficiency Virus) care and treatment. Its use has led to a marked reduction in AIDS (Acquired Immune Deficiency Syndrome) related morbidity and mortality. However, more than fi ve years after their introduction few HIV infected people in Nepal are receiving ARVs.
The main aim of this study is to identify barriers and obstacles to providing and expanding ARV programmes in Nepal.
A qualitative approach consisting of in-depth interviews with three groups of stakeholders:policy makers, ARV service providers and ARV recipients were carried out. The transcripts were analysed using a thematic approach.
The estimated number of people in need was high compared with people currently receiving ARV in Nepal. With regards to the proper distribution of the ARVs, the main problems identified in the interviews were: lack of infrastructure, lack of human resources, financial constraints, programmatic problems, weak leadership and management at national level, poor cooperation between management structures, geographical barriers, lack of awareness and low uptake of counselling and/or testing, stigmatization and discrimination felt by the health workers and the community, lack of coordination and limited access to services.
Limited resources and administrative capacity coupled with strong underlying needs for services pose serious challenges to the government. Despite this, better use could be made of existing services and resources to help benefit more people from ARV.
抗逆转录病毒（ARV）药物已成为艾滋病毒（人类免疫缺陷病毒）护理和治疗的基石。其使用已导致与艾滋病（获得性免疫缺陷综合征）相关的发病率和死亡率显著降低。然而，在引入这些药物五年多后，尼泊尔很少有艾滋病毒感染者接受抗逆转录病毒药物治疗。
本研究的主要目的是确定在尼泊尔提供和扩大抗逆转录病毒药物治疗项目的障碍和阻碍。
采用定性研究方法，对三组利益相关者进行深入访谈：政策制定者、抗逆转录病毒药物服务提供者和抗逆转录病毒药物接受者。使用主题分析法对访谈记录进行分析。
与尼泊尔目前接受抗逆转录病毒药物治疗的人数相比，估计有需求的人数较多。关于抗逆转录病毒药物的合理分配，访谈中确定的主要问题包括：基础设施不足、人力资源缺乏、资金限制、项目问题、国家层面领导和管理薄弱、管理结构之间合作不力、地理障碍、缺乏认识以及咨询和/或检测的接受率低、卫生工作者和社区感受到的污名化和歧视、缺乏协调以及服务获取有限。
资源和行政能力有限，加上对服务的潜在需求强烈，给政府带来了严峻挑战。尽管如此，可以更好地利用现有服务和资源，帮助更多人从抗逆转录病毒药物治疗中受益。
