Kolawole Grace O, Gilbert Hannah N, Dadem Nancin Y, Genberg Becky L, Agaba Patricia A, Okonkwo Prosper, Agbaji Oche O, Ware Norma C
Infectious Diseases Unit, Jos University Teaching Hospital, Jos, Nigeria.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
AIDS Res Treat. 2017;2017:2838059. doi: 10.1155/2017/2838059. Epub 2017 Feb 26.
Decentralization of care and treatment for HIV infection in Africa makes services available in local health facilities. Decentralization has been associated with improved retention and comparable or superior treatment outcomes, but patient experiences are not well understood. We conducted a qualitative study of patient experiences in decentralized HIV care in Plateau State, north central Nigeria. Five decentralized care sites in the Plateau State Decentralization Initiative were purposefully selected. Ninety-three patients and 16 providers at these sites participated in individual interviews and focus groups. Data collection activities were audio-recorded and transcribed. Transcripts were inductively content analyzed to derive descriptive categories representing patient experiences of decentralized care. Patient participants in this study experienced the transition to decentralized care as a series of "trade-offs." Advantages cited included saving time and money on travel to clinic visits, avoiding dangers on the road, and the "family-like atmosphere" found in some decentralized clinics. Disadvantages were loss of access to ancillary services, reduced opportunities for interaction with providers, and increased risk of disclosure. Participants preferred decentralized services overall. Difficulty and cost of travel remain a fundamental barrier to accessing HIV care outside urban centers, suggesting increased availability of community-based services will be enthusiastically received.
非洲地区艾滋病病毒感染护理与治疗的去中心化，使得当地卫生设施能够提供相关服务。去中心化与提高留存率以及可比或更优的治疗效果相关，但患者的体验尚未得到充分了解。我们对尼日利亚中北部高原州去中心化艾滋病病毒护理中的患者体验进行了一项定性研究。在高原州去中心化倡议中，有目的地选取了五个去中心化护理点。这些护理点的93名患者和16名医护人员参与了个人访谈和焦点小组。数据收集活动进行了录音和转录。对转录内容进行归纳性内容分析，以得出代表去中心化护理患者体验的描述性类别。本研究中的患者参与者将向去中心化护理的转变体验为一系列“权衡”。提到的优点包括节省前往诊所就诊的时间和金钱、避免路上的危险，以及一些去中心化诊所中“家庭般的氛围”。缺点是无法获得辅助服务、与医护人员互动的机会减少，以及暴露风险增加。总体而言，参与者更喜欢去中心化服务。出行的困难和成本仍然是在城市中心以外地区获得艾滋病病毒护理的一个基本障碍，这表明增加社区服务的可及性将受到热烈欢迎。
