Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, PO Box 19676, 00202 Nairobi, Kenya.
BMC Public Health. 2012 Aug 20;12:677. doi: 10.1186/1471-2458-12-677.
Harmful alcohol use has been linked to the spread of HIV in Kenya. It also adversely affects those on antiretroviral (ARV) treatment through poor compliance. This study using participatory research and action (PRA) methods sought to understand factors related to alcohol abuse and non-adherence and to formulate appropriate interventions in a sample of people living with HIV and AIDS (PLWHA) who were also abusing alcohol, at Kariobangi in Nairobi, Kenya.
Entry into the community was gained through previous PRA work in that community and PLWHA were recruited through snowballing. Working together with the community members, the researchers explored the participants' understanding of alcohol use problem, its effects on compliance to ARV treatment and discussed possible action areas through PRA techniques that included focus group and market place discussions; visual aids such as spider diagrams, community mapping and ranking. Follow-up meetings were held to discuss the progress.
By the final meeting, 67 PLWHA and 19 community members had been recruited. Through discussions, misconceptions regarding alcohol use were identified. It emerged that alcohol abuse was poorly recognised among both the community and health workers. Screening for alcohol use was not routinely done and protocols for managing alcohol related disorders were not available at the local health centres providing ARVs. The study participants identified improving communication, psychoeducation and screening for alcohol use as possible action areas. Poverty was identified as a major problem but the interventions to mitigate this were not easy to implement.
We propose that PRA could be useful in improving communication between the health workers and the clients attending primary health care (PHC) facilities and can be applied to strengthen involvement of support groups and community health workers in follow up and counselling. Integrating these features into primary health care (PHC) would be important not only to PLWHA but also to other diseases in the PHC setting . Longer term follow up is needed to determine the sustained impact of the interventions. Problems encountered in the PRA work included great expectations at all levels fostered by handouts from other donors and cognitive impairment that interfered with constructive engagement in some of the PLWHA.
在肯尼亚，有害饮酒与 HIV 的传播有关。它还通过降低药物依从性对接受抗逆转录病毒（ARV）治疗的人产生不利影响。本研究采用参与式研究和行动（PRA）方法，旨在了解与酒精滥用和不依从相关的因素，并在肯尼亚内罗毕卡里奥邦吉的一组同时滥用酒精的艾滋病毒/艾滋病（PLWHA）患者中制定适当的干预措施。
通过该社区之前的 PRA 工作进入社区，并通过滚雪球的方式招募 PLWHA。研究人员与社区成员一起，探讨了参与者对酒精使用问题的理解、其对 ARV 治疗依从性的影响，并通过 PRA 技术（包括焦点小组和市场讨论、蜘蛛图、社区绘图和排名等视觉辅助工具）讨论了可能的行动领域。随后举行了后续会议以讨论进展情况。
在最后一次会议上，共招募了 67 名 PLWHA 和 19 名社区成员。通过讨论，确定了对酒精使用的误解。结果表明，社区和卫生工作者都没有很好地认识到酗酒问题。没有对酒精使用情况进行常规筛查，提供 ARV 的当地卫生中心也没有管理与酒精相关的疾病的方案。研究参与者确定了改善沟通、心理教育和酒精使用筛查作为可能的行动领域。贫困被确定为一个主要问题，但减轻贫困的干预措施实施起来并不容易。
我们提出，PRA 可以有效地改善初级卫生保健（PHC）设施中卫生工作者和就诊患者之间的沟通，并且可以应用于加强支持小组和社区卫生工作者在随访和咨询中的参与。将这些功能纳入初级卫生保健（PHC）不仅对 PLWHA 而且对 PHC 环境中的其他疾病都很重要。需要进行长期随访以确定干预措施的持续影响。在 PRA 工作中遇到的问题包括各级人员对其他捐助者的宣传册所产生的过高期望，以及一些 PLWHA 认知障碍，这些障碍干扰了他们建设性的参与。
