Banks Lena Morgon, Zuurmond Maria, Ferrand Rashida, Kuper Hannah
International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLoS One. 2017 Aug 9;12(8):e0181144. doi: 10.1371/journal.pone.0181144. eCollection 2017.
While the rapid expansion in antiretroviral therapy access in low and middle income countries has resulted in dramatic declines in mortality rates, many people living with HIV face new or worsening experiences of disability. As nearly 1 in 20 adults are living with HIV in sub-Saharan Africa-many of whom are likely to develop disabling sequelae from long-term infection, co-morbidities and side effects of their treatment-understanding the availability and accessibility of services to address HIV-related disabilities is of vital importance. The aim of this study thus is to explore knowledge of HIV-related disabilities amongst stakeholders working in the fields of HIV and disability and factors impacting uptake and provision of interventions for preventing, treating or managing HIV-related disabilities.
In-depth, semi-structured interviews were conducted with ten stakeholders based in Harare, Zimbabwe, who were working in the fields of either disability or HIV. Stakeholders were identified through a priori stakeholder analysis. Thematic Analysis, complemented by constant comparison as described in Grounded Theory, was used to analyse findings.
All key informants reported some level of knowledge of HIV-related disability, mostly from observations made in their line of work. However, they reported no interventions or policies were in place specifically to address HIV-related disability. While referrals between HIV and rehabilitation providers were not uncommon, no formal mechanisms had been established for collaborating on prevention, identification and management. Additional barriers to accessing and providing services to address HIV-related disabilities included: the availability of resources, including trained professionals, supplies and equipment in both the HIV and rehabilitation sectors; lack of disability-inclusive adaptations, particularly in HIV services; heavy centralization of available services in urban areas, without accessible, affordable transportation links; and attitudes and understanding among service providers and people living with HIV-related disabilities.
As people living with HIV are surviving longer, HIV-related disabilities will become a major source of disability globally, particularly in sub-Saharan Africa where infection is endemic. Preventing, treating and managing HIV-related disabilities must become a key component of both HIV response efforts and rehabilitation strategies.
虽然中低收入国家抗逆转录病毒疗法的可及性迅速扩大，导致死亡率大幅下降，但许多艾滋病毒感染者面临新的残疾问题或残疾状况恶化。由于撒哈拉以南非洲近二十分之一的成年人感染了艾滋病毒——其中许多人可能因长期感染、合并症及其治疗的副作用而出现致残后遗症，了解应对艾滋病毒相关残疾的服务的可获得性和可及性至关重要。因此，本研究的目的是探讨在艾滋病毒和残疾领域工作的利益相关者对艾滋病毒相关残疾的了解，以及影响预防、治疗或管理艾滋病毒相关残疾干预措施的采用和提供的因素。
对津巴布韦哈拉雷的十位在残疾或艾滋病毒领域工作的利益相关者进行了深入的半结构化访谈。利益相关者通过先验利益相关者分析确定。采用主题分析法，并辅以扎根理论中所述的持续比较法来分析研究结果。
所有关键信息提供者都报告了一定程度的艾滋病毒相关残疾知识，大多来自他们工作中的观察。然而，他们报告说没有专门针对艾滋病毒相关残疾的干预措施或政策。虽然艾滋病毒和康复服务提供者之间的转诊并不罕见，但尚未建立预防、识别和管理方面的正式合作机制。获取和提供应对艾滋病毒相关残疾服务的其他障碍包括：艾滋病毒和康复部门的资源可用性，包括训练有素的专业人员、用品和设备；缺乏对残疾的包容性调整，特别是在艾滋病毒服务中；现有服务高度集中在城市地区，缺乏便捷、负担得起的交通连接；以及服务提供者和艾滋病毒相关残疾者的态度和理解。
随着艾滋病毒感染者的寿命延长，艾滋病毒相关残疾将成为全球残疾的主要来源，特别是在艾滋病毒感染流行的撒哈拉以南非洲。预防、治疗和管理艾滋病毒相关残疾必须成为艾滋病毒应对工作和康复战略的关键组成部分。
