Médecins Sans Frontières (MSF), London, UK; London School of Hygiene and Tropical Medicine, London, UK.
MSF, Nhlangano, Swaziland.
Soc Sci Med. 2017 Mar;176:52-59. doi: 10.1016/j.socscimed.2017.01.006. Epub 2017 Jan 6.
Timely uptake of antiretroviral therapy, adherence and retention in care for people living with HIV (PLHIV) can improve health outcomes and reduce transmission. Médecins Sans Frontières and the Swaziland Ministry of Health provide community-based HIV testing services (HTS) in Shiselweni, Swaziland, with high HTS coverage but sub-optimal linkage to HIV care. This qualitative study examined factors influencing linkage to HIV care for PLHIV diagnosed by community-based HTS.
Participants were sampled purposively, exploring linkage experiences among both genders and different age groups. Interviews were conducted with 28 PLHIV (linked and not linked) and 11 health practitioners. Data were thematically analysed to identify emergent patterns and categories using NVivo 10. Principles of grounded theory were applied, including constant comparison of findings, raising codes to a conceptual level, and inductively generating theory from participant accounts.
The process of HIV status acceptance or denial influenced the accounts of patients' health seeking and linkage to care. This process was non-linear and varied temporally, with some experiencing non-acceptance for an extended period of time. Non-acceptance was linked to perceptions of HIV risk, with those not identifying as at risk less likely to expect and therefore be prepared for a positive result. Status disclosure was seen to support linkage, reportedly occurring after the acceptance of HIV status. HIV status acceptance motivated health seeking and tended to be accompanied by a perceived need for, and positive value placed on, HIV health care.
The manner in which PLHIV process a positive result can influence their engagement with HIV treatment and care. Thus, there is a need for individually tailored approaches to HTS, including the potential for counselling over multiple sessions if required, supporting status acceptance, and disclosure. This is particularly relevant considering 90-90-90 targets and the need to better support PLHIV to engage with HIV treatment and care following diagnosis.
及时接受抗逆转录病毒治疗、坚持治疗和留在艾滋病病毒感染者（PLHIV）护理中，可以改善健康结果并减少传播。无国界医生组织和斯威士兰卫生部在斯威士兰的 Shiselweni 提供基于社区的艾滋病毒检测服务（HTS），这些服务的 HTS 覆盖率很高，但与艾滋病毒护理的联系不太理想。这项定性研究调查了通过社区为基础的 HTS 诊断的 PLHIV 与艾滋病毒护理联系的影响因素。
参与者是有目的抽样的，探索了不同性别和不同年龄组之间的联系经验。对 28 名 PLHIV（已联系和未联系）和 11 名卫生保健工作者进行了访谈。使用 NVivo 10 对数据进行主题分析，以识别出出现的模式和类别。应用扎根理论的原则，包括对研究结果的不断比较、将代码提升到概念水平，以及从参与者的叙述中归纳理论。
HIV 状态的接受或否认过程影响了患者寻求健康和与护理联系的情况。这个过程是非线性的，随着时间的推移而变化，有些人在很长一段时间内都不接受。不接受与对 HIV 风险的看法有关，那些不认为自己有风险的人不太可能期望并因此为阳性结果做好准备。状态披露被认为有助于联系，据报道是在接受 HIV 状态后发生的。HIV 状态的接受促使人们寻求健康，并倾向于伴随着对 HIV 保健的需求和积极的价值。
PLHIV 处理阳性结果的方式会影响他们接受 HIV 治疗和护理的情况。因此，需要针对 HTS 采用个性化的方法，包括在需要时提供多次咨询的可能性，支持状态接受和披露。考虑到 90-90-90 目标和需要更好地支持 PLHIV 在诊断后参与 HIV 治疗和护理，这一点尤其重要。
