Scott K, Campbell C, Madanhire C, Skovdal M, Nyamukapa C, Gregson S
Social and Behavioral Interventions, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room E5533, 615 North Wolfe Street, Baltimore, MD 21205, USA
Institute of Social Psychology, London School of Economics and Political Science, London, UK.
Health Promot Int. 2014 Dec;29(4):645-54. doi: 10.1093/heapro/dat014. Epub 2013 Mar 15.
Little research has been conducted on how pre-existing indigenous community resources, especially social networks, affect the success of externally imposed HIV interventions. Antiretroviral treatment (ART), an externally initiated biomedical intervention, is being rolled out across sub-Saharan Africa. Understanding the ways in which community networks are working to facilitate optimal ART access and adherence will enable policymakers to better engage with and bolster these pre-existing resources. We conducted 67 interviews and eight focus group discussions with 127 people from three key population groups in Manicaland, eastern Zimbabwe: healthcare workers, adults on ART and carers of children on ART. We also observed over 100 h of HIV treatment sites at local clinics and hospitals. Our research sought to determine how indigenous resources were enabling people to achieve optimal ART access and adherence. We analysed data transcripts using thematic network technique, coding references to supportive community networks that enable local people to achieve ART access and adherence. People on ART or carers of children on ART in Zimbabwe report drawing support from a variety of social networks that enable them to overcome many obstacles to adherence. Key support networks include: HIV groups; food and income support networks; home-based care, church and women's groups; family networks; and relationships with healthcare providers. More attention to the community context in which HIV initiatives occur will help ensure that interventions work with and benefit from pre-existing social capital.
关于既有的本土社区资源，尤其是社会网络，如何影响外部强加的艾滋病干预措施的成效，目前开展的研究很少。抗逆转录病毒治疗（ART）作为一种由外部发起的生物医学干预措施，正在撒哈拉以南非洲地区推广。了解社区网络促进最佳抗逆转录病毒治疗可及性和依从性的方式，将使政策制定者能够更好地参与并加强这些既有的资源。我们对来自津巴布韦东部马尼卡兰三个关键人群组的127人进行了67次访谈和8次焦点小组讨论，这三个关键人群组分别是医护人员、接受抗逆转录病毒治疗的成年人以及接受抗逆转录病毒治疗儿童的照料者。我们还在当地诊所和医院观察了超过100小时的艾滋病治疗场所。我们的研究旨在确定本土资源如何使人们实现最佳的抗逆转录病毒治疗可及性和依从性。我们使用主题网络技术分析数据记录，对支持性社区网络的相关内容进行编码，这些网络使当地人能够实现抗逆转录病毒治疗的可及性和依从性。津巴布韦接受抗逆转录病毒治疗的人或接受抗逆转录病毒治疗儿童的照料者报告称，他们从各种社会网络中获得支持，这些网络使他们能够克服依从性方面的许多障碍。关键的支持网络包括：艾滋病群体；食物和收入支持网络；居家护理、教会和妇女团体；家庭网络；以及与医护人员的关系。更多关注艾滋病防治举措所处的社区环境将有助于确保干预措施与既有的社会资本协同发挥作用并从中受益。
