Obua Celestino, Gusdal Annelie, Waako Paul, Chalker John C, Tomson Goran, Wahlström Rolf, Team The Inrud-Iaa
Makerere University, College of Health Sciences, School of Biomedical Sciences, Department of Pharmacology and Therapeutics, Kampala, Uganda.
Open AIDS J. 2011;5:17-24. doi: 10.2174/1874613601105010017. Epub 2011 Mar 18.
Increased availability and accessibility of antiretroviral therapy (ART) has improved the length and quality of life amongst people living with HIV/AIDS. This has changed the landscape for care from episodic to long-term care that requires more monitoring of adherence. This has led to increased demand on human resources, a major problem for most ART programs. This paper presents experiences and perspectives of providers in ART facilities, exploring the organizational factors affecting their capacity to monitor adherence to ARVs.
From an earlier survey to test adherence indicators and rank facilities as good, medium or poor adherence performances, six facilities were randomly selected, two from each rank. Observations on facility set-up, provider-patient interactions and key informant interviews were carried out. The strengths, weaknesses, opportunities and threats identified by health workers as facilitators or barriers to their capacity to monitor adherence to ARVs were explored during group discussions.
Findings show that the performance levels of the facilities were characterized by four different organizational ART programs operating in Uganda, with apparent lack of integration and coordination at the facilities. Of the six facilities studied, the two high adherence performing facilities were Non-Governmental Organization (NGO) programs, while facilities with dual organizational programs (Governmental/NGO) performed poorly. Working conditions, record keeping and the duality of programs underscored the providers' capacity to monitor adherence. Overall 70% of the observed provider-patient interactions were conducted in environments that ensured privacy of the patient. The mean performance for record keeping was 79% and 50% in the high and low performing facilities respectively. Providers often found it difficult to monitor adherence due to the conflicting demands from the different organizational ART programs.
Organizational duality at facilities is a major factor in poor adherence monitoring. The different ART programs in Uganda need to be coordinated and integrated into a single well resourced program to improve ART services and adherence monitoring. The focus on long-term care of patients on ART requires that the limitations to providers' capacity for monitoring adherence become central during the planning and implementation of ART programs.
抗逆转录病毒疗法（ART）的可及性和可获得性提高，改善了艾滋病毒/艾滋病感染者的寿命和生活质量。这已改变了护理格局，从偶尔护理转变为长期护理，需要更多地监测依从性。这导致对人力资源的需求增加，这是大多数抗逆转录病毒疗法项目面临的一个主要问题。本文介绍了抗逆转录病毒疗法设施中提供者的经验和观点，探讨了影响他们监测抗逆转录病毒药物依从性能力的组织因素。
从早期一项测试依从性指标并将设施评为依从性表现良好、中等或较差的调查中，随机选择了六个设施，每个等级各选两个。对设施设置、提供者与患者的互动进行了观察，并进行了关键信息访谈。在小组讨论中，探讨了卫生工作者确定的作为其监测抗逆转录病毒药物依从性能力的促进因素或障碍的优势、劣势、机会和威胁。
研究结果表明，这些设施的绩效水平以乌干达开展的四种不同组织抗逆转录病毒疗法项目为特征，各设施明显缺乏整合与协调。在所研究的六个设施中，两个依从性表现高的设施是非政府组织项目，而具有双重组织项目（政府/非政府组织）的设施表现较差。工作条件、记录保存以及项目的双重性突出了提供者监测依从性的能力。总体而言，观察到的提供者与患者互动中有70%是在确保患者隐私的环境中进行的。高绩效和低绩效设施记录保存的平均表现分别为79%和50%。由于不同组织抗逆转录病毒疗法项目的需求相互冲突，提供者常常发现难以监测依从性。
设施的组织双重性是依从性监测不佳的一个主要因素。乌干达不同的抗逆转录病毒疗法项目需要进行协调并整合为一个资源充足的单一项目，以改善抗逆转录病毒疗法服务和依从性监测。对抗逆转录病毒疗法患者长期护理的关注要求在抗逆转录病毒疗法项目的规划和实施过程中，将提供者监测依从性能力的限制作为核心问题。
