Rakai Health Sciences Program, P.O. Box 279, Kalisizo, Rakai, Uganda.
Biomed Res Int. 2013;2013:470245. doi: 10.1155/2013/470245. Epub 2013 Aug 22.
Early entry into HIV care is low in Sub-Saharan Africa. In Rakai, about a third (31.5%) of HIV-positive clients who knew their serostatus did not enroll into free care services. This qualitative study explored barriers to entry into care from HIV-positive clients who had never enrolled in care and HIV care providers.
We conducted 48 in-depth interviews among HIV-infected individuals aged 15-49 years, who had not entered care within six months of result receipt and referral for free care. Key-informant interviews were conducted with 12 providers. Interviews were audio-recorded and transcripts subjected to thematic content analysis based on the health belief model.
Barriers to using HIV care included fear of stigma and HIV disclosure, women's lack of support from male partners, demanding work schedules, and high transport costs. Programmatic barriers included fear of antiretroviral drug side effects, long waiting and travel times, and inadequate staff respect for patients. Denial of HIV status, belief in spiritual healing, and absence of AIDS symptoms were also barriers.
Targeted interventions to combat stigma, strengthen couple counseling and health education programs, address gender inequalities, and implement patient-friendly and flexible clinic service hours are needed to address barriers to HIV care.
在撒哈拉以南非洲，早期进入艾滋病护理的比例较低。在 Rakai，约三分之一（31.5%）知道自己血清阳性的艾滋病毒阳性客户并未登记接受免费护理服务。本项定性研究从从未登记接受护理的艾滋病毒阳性客户和艾滋病毒护理提供者的角度探讨了进入护理的障碍。
我们对 15-49 岁的艾滋病毒感染者进行了 48 次深入访谈，这些感染者在收到结果并被转介接受免费护理后六个月内尚未登记接受护理。对 12 名提供者进行了重点访谈。访谈进行了录音，并根据健康信念模型对记录进行了主题内容分析。
使用艾滋病护理的障碍包括对污名和艾滋病毒披露的恐惧、女性缺乏男性伴侣的支持、工作时间要求苛刻以及交通费用高。方案障碍包括对抗逆转录病毒药物副作用、长时间等待和旅行时间以及工作人员对患者的尊重不足的恐惧。否认艾滋病毒状况、对精神治疗的信仰以及没有艾滋病症状也是障碍。
需要采取有针对性的干预措施，打击污名、加强伴侣咨询和健康教育计划、解决性别不平等问题，并实施对患者友好和灵活的诊所服务时间，以解决艾滋病毒护理的障碍。
