实施与运营研究：肯尼亚西部预防艾滋病毒传播咨询及抗逆转录病毒治疗依从性信息的时间动作分析
Implementation and Operational Research: A Time-Motion Analysis of HIV Transmission Prevention Counseling and Antiretroviral Adherence Messages in Western Kenya.
作者信息
Were Martin C, Kessler Jason, Shen Changyu, Sidle John, Macharia Stephen, Lizcano John, Siika Abraham, Wools-Kaloustian Kara, Kurth Ann
机构信息
*Department of Internal Medicine, School of Medicine, Indiana University, Indianapolis, IN; †Regenstrief Institute Inc., Indianapolis, IN; ‡Department of Population Health, School of Medicine, New York University, New York, NY; §Moi Teaching and Referral Hospital, Eldoret, Kenya; ‖College of Nursing, New York University, New York, NY; ¶Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya; #Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; and **New York University College of Global Public Health, College of Nursing, New York University, New York, NY.
出版信息
J Acquir Immune Defic Syndr. 2015 Aug 1;69(4):e135-41. doi: 10.1097/QAI.0000000000000666.
BACKGROUND
Shortages of health workers and large number of HIV-infected persons in Africa mean that time to provide antiretroviral therapy (ART) adherence and other messages to patients is limited.
METHODS
Using time-motion methodology, we documented the intensity and nature of counseling delivered to patients. The study was conducted at a rural and an urban HIV clinic in western Kenya. We recorded all activities of 190 adult patients on ART during their return clinic visits to assess type, frequency, and duration of counseling messages.
RESULTS
Mean visit length for patients at the rural clinic was 44.5 (SD = 27.9) minutes and at urban clinic was 78.2 (SD = 42.1) minutes. Median time spent receiving any counseling during a visit was 4.07 minutes [interquartile range (IQR), 1.57-7.33] at rural and 3.99 (IQR, 2.87-6.25) minutes at urban, representing 11% and 8% of total mean visit time, respectively. Median time patients received ART adherence counseling was 1.29 (IQR, 0.77-2.83) minutes at rural and 1.76 (IQR, 1.23-2.83) minutes at urban (P = 0.001 for difference). Patients received a median time of 0.18 (0-0.72) minutes at rural and 0.28 (IQR, 0-0.67) minutes at urban clinic of counseling regarding contraception and pregnancy. Most patients in the study did not receive any counseling regarding alcohol/substance use, emerging risks for ongoing HIV transmission.
CONCLUSIONS
Although ART adherence was discussed with most patients, time was limited. Reproductive counseling was provided to only half of the patients, and "positive prevention" messaging was minimal. There are strategic opportunities to enhance counseling and information received by clients within HIV programs in resource-limited settings.
背景
非洲卫生工作者短缺且艾滋病毒感染者众多，这意味着向患者提供抗逆转录病毒疗法（ART）依从性及其他信息的时间有限。
方法
我们采用时间动作研究方法，记录了为患者提供咨询的强度和性质。该研究在肯尼亚西部的一家农村和一家城市艾滋病毒诊所进行。我们记录了190名接受抗逆转录病毒治疗的成年患者在复诊期间的所有活动，以评估咨询信息的类型、频率和持续时间。
结果
农村诊所患者的平均就诊时长为44.5（标准差 = 27.9）分钟，城市诊所为78.2（标准差 = 42.1）分钟。农村患者每次就诊接受任何咨询的中位时间为4.07分钟[四分位间距（IQR），1.57 - 7.33]，城市为3.99分钟（IQR，2.87 - 6.25），分别占平均总就诊时间的11%和8%。农村患者接受抗逆转录病毒疗法依从性咨询的中位时间为1.29分钟（IQR，0.77 - 2.83），城市为1.76分钟（IQR，1.23 - 2.83）（差异P = 0.001）。农村诊所患者接受避孕和怀孕咨询的中位时间为0.18（0 - 0.72）分钟，城市诊所为0.28分钟（IQR，0 - 0.67）。研究中的大多数患者未接受任何关于酒精/药物使用及正在进行的艾滋病毒传播新风险的咨询。
结论
虽然与大多数患者讨论了抗逆转录病毒疗法的依从性，但时间有限。仅对一半的患者提供了生殖咨询，且“积极预防”信息极少。在资源有限的环境中，艾滋病毒项目有战略机会加强客户所接受的咨询和信息。
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