FHI 360, Washington, DC, USA.
Glob Health Sci Pract. 2016 Dec 28;4(4):610-625. doi: 10.9745/GHSP-D-16-00195. Print 2016 Dec 23.
Supporting the diverse needs of people living with HIV (PLHIV) can help reduce the individual and structural barriers they face in adhering to antiretroviral treatment (ART). The Livelihoods and Food Security Technical Assistance II (LIFT) project sought to improve adherence in Malawi by establishing 2 referral systems linking community-based economic strengthening and livelihoods services to clinical health facilities. One referral system in Balaka district, started in October 2013, connected clients to more than 20 types of services while the other simplified approach in Kasungu and Lilongwe districts, started in July 2014, connected PLHIV attending HIV and nutrition support facilities directly to community savings groups.
From June to July 2015, LIFT visited referral sites in Balaka, Kasungu, and Lilongwe districts to collect qualitative data on referral utility, the perceived association of referrals with client and household health and vulnerability, and the added value of the referral system as perceived by network member providers. We interviewed a random sample of 152 adult clients (60 from Balaka, 57 from Kasungu, and 35 from Lilongwe) who had completed their referral. We also conducted 2 focus group discussions per district with network providers.
Clients in all 3 districts indicated their ability to save money had improved after receiving a referral, although the percentage was higher among clients in the simplified Kasungu and Lilongwe model than the more complex Balaka model (85.6% vs. 56.0%, respectively). Nearly 70% of all clients interviewed had HIV infection; 72.7% of PLHIV in Balaka and 95.7% of PLHIV in Kasungu and Lilongwe credited referrals for helping them stay on their ART. After the referral, 76.0% of clients in Balaka and 92.3% of clients in Kasungu and Lilongwe indicated they would be willing to spend their savings on health costs. The more diverse referral network and use of an mHealth app to manage data in Balaka hindered provider uptake of the system, while the simpler system in Kasungu and Lilongwe, which included only 2 referral options and use of a paper-based referral tool, seemed simpler for the providers to manage.
Participation in the referral systems was perceived positively by clients and providers in both models, but more so in Kasungu and Lilongwe where the referral process was simpler. Future referral networks should consider limiting the number of service options included in the network and simplify referral tools to the extent possible to facilitate uptake among network providers.
支持艾滋病毒感染者（PLHIV）的多样化需求有助于减少他们在接受抗逆转录病毒治疗（ART）方面面临的个人和结构障碍。生计和粮食安全技术援助二期（LIFT）项目试图通过建立两个转诊系统来改善马拉维的遵医行为，该系统将社区经济加强和生计服务与临床保健设施联系起来。2013 年 10 月在巴拉卡区启动的一个转诊系统为客户提供了 20 多种服务，而 2014 年 7 月在卡松古和利隆圭区启动的另一个简化方法则将接受艾滋病毒和营养支持设施的 PLHIV 直接与社区储蓄小组联系起来。
2015 年 6 月至 7 月，LIFT 访问了巴拉卡、卡松古和利隆圭区的转诊地点，收集有关转诊效用的定性数据、转诊与客户和家庭健康和脆弱性的关联、以及网络成员提供者认为转诊系统的附加值。我们采访了 152 名完成转诊的成年客户（巴拉卡 60 名，卡松古 57 名，利隆圭 35 名）的随机样本。我们还在每个地区进行了两次网络提供者焦点小组讨论。
所有三个地区的客户都表示，在接受转诊后，他们的存钱能力有所提高，尽管在简化的卡松古和利隆圭模式中，客户的比例高于更为复杂的巴拉卡模式（分别为 85.6%和 56.0%）。接受采访的所有客户中，近 70%的人感染了 HIV；巴拉卡的 72.7%和卡松古和利隆圭的 95.7%的 PLHIV 认为转诊有助于他们坚持接受 ART。转诊后，巴拉卡的 76.0%和卡松古和利隆圭的 92.3%的客户表示愿意将储蓄用于医疗费用。巴拉卡多样化的转诊网络和使用移动健康应用程序来管理数据阻碍了提供者对该系统的采用，而卡松古和利隆圭的系统更为简单，仅包括 2 个转诊选项和使用纸质转诊工具，对提供者来说更容易管理。
在两种模式中，客户和提供者都对转诊系统给予了积极的评价，但在卡松古和利隆圭模式中，转诊过程更为简单，评价更为积极。未来的转诊网络应考虑尽可能限制网络中包含的服务选项数量，并简化转诊工具，以促进网络提供者的采用。
