Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Nelson Mandela Drive, Park West, Bloemfontein 9301, South Africa.
BMC Health Serv Res. 2013 May 7;13:171. doi: 10.1186/1472-6963-13-171.
The integration of HIV care into primary care services is one of the strategies proposed to increase access to treatment for people living with HIV/AIDS in high HIV burden countries. However, how best to do this is poorly understood. This study documents different factors influencing models of integration within clinics.
Using methods based on the meta-ethnographic approach, we synthesised the findings from three qualitative studies of the factors that influenced integration of HIV care into all consultations in primary care. The studies were conducted amongst staff and patients in South Africa during a randomised trial of nurse initiation of antiretroviral therapy (ART) and integration of HIV care into primary care services - the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) trial. Themes from each study were identified and translated into each other to develop categories and sub-categories and then to inform higher level interpretations of the synthesised data.
Clinics varied as to how HIV care was integrated. Existing administration systems, workload and support staff shortages tended to hinder integration. Nurses' wanted to be involved in providing HIV care and yet also expressed preferences for developing expertise in certain areas and for establishing good nurse patient relationships by specialising in certain services. Patients, in turn, were concerned about the stigma of separate HIV services and yet preferred to be seen by nurses with expertise in HIV care. These factors had conflicting effects on efforts to integrate HIV care.
Local clinic factors and nurse and patient preferences in relation to care delivery should be taken into account in programmes to integrate HIV care into primary care services. The integration of medical records, monitoring and reporting systems would support clinic based efforts to integrate HIV care into primary care services.
将艾滋病毒护理纳入初级保健服务是在高艾滋病毒负担国家增加艾滋病毒感染者/艾滋病患者获得治疗机会的建议策略之一。然而，如何最好地实现这一目标仍知之甚少。本研究记录了影响诊所内整合模式的不同因素。
我们使用基于元人种学方法的方法，综合了三项定性研究的结果，这些研究探讨了影响将艾滋病毒护理纳入初级保健所有咨询中的因素。这些研究是在南非进行的，是在一项随机试验中进行的，该试验旨在对护士启动抗逆转录病毒疗法（ART）和将艾滋病毒护理纳入初级保健服务进行整合 - 简化任务和角色以扩大艾滋病毒治疗和护理（STRETCH）试验。从每个研究中确定主题并将其翻译成彼此，以开发类别和子类别，然后告知综合数据的更高层次解释。
诊所的艾滋病毒护理整合方式各不相同。现有的行政系统、工作量和支持人员短缺往往会阻碍整合。护士希望参与提供艾滋病毒护理，但也表示希望在某些领域发展专业知识，并通过专门从事某些服务来建立良好的护士患者关系。反过来，患者担心单独的艾滋病毒服务带来的耻辱感，但更愿意由具有艾滋病毒护理专业知识的护士为其服务。这些因素对整合艾滋病毒护理的努力产生了冲突的影响。
在将艾滋病毒护理纳入初级保健服务的方案中，应考虑当地诊所因素以及与护理提供有关的护士和患者偏好。医疗记录、监测和报告系统的整合将支持以诊所为基础的努力，将艾滋病毒护理纳入初级保健服务。
