Steward Wayne T, Sumitani Jeri, Moran Mary E, Ratlhagana Mary-Jane, Morris Jessica L, Isidoro Lebogang, Gilvydis Jennifer M, Tumbo John, Grignon Jessica, Barnhart Scott, Lippman Sheri A
a Center for AIDS Prevention Studies, University of California San Francisco , San Francisco , USA.
b International Training and Education Center for Health - South Africa , Pretoria , Republic of South Africa.
AIDS Care. 2018 Mar;30(3):330-337. doi: 10.1080/09540121.2017.1363362. Epub 2017 Aug 16.
Antiretroviral therapy (ART) could curtail the HIV epidemic, but its impact is diminished by low uptake. We developed a peer navigation program to enhance engagement in HIV care, ART adherence, and behavioral prevention. In preparation for a randomized controlled trial, the program was piloted over four months at two primary health clinics in South Africa's North West Province. Newly diagnosed, HIV-positive clients met regularly with navigators to address barriers to care, adherence, and prevention. To assess program acceptability and feasibility and characterize the mechanisms of action, we surveyed 25 clients who completed navigation services and conducted interviews with 10 clients, four navigators, and five clinic providers. Clients expressed near universal approval for the program and were satisfied with the frequency of contact with navigators. HIV stigma emerged as a primary driver of barriers to care. Navigators helped clients overcome feelings of shame through education and by modeling how to live successfully with HIV. They addressed discrimination fears by helping clients disclose to trusted individuals. These actions, in turn, facilitated clients' care engagement, ART adherence, and HIV prevention efforts. The findings suggest peer navigation is a feasible approach with potential to maximize the impact of ART-based HIV treatment and prevention strategies.
抗逆转录病毒疗法（ART）可以遏制艾滋病疫情，但由于接受率低，其影响有所减弱。我们开发了一个同伴导航项目，以提高对艾滋病护理的参与度、抗逆转录病毒疗法的依从性和行为预防。在准备进行一项随机对照试验时，该项目在南非西北省的两家初级保健诊所进行了为期四个月的试点。新诊断出的艾滋病毒呈阳性的患者定期与导航员会面，以解决护理、依从性和预防方面的障碍。为了评估该项目的可接受性和可行性，并描述其作用机制，我们对25名完成导航服务的患者进行了调查，并对10名患者、4名导航员和5名诊所提供者进行了访谈。患者对该项目几乎一致表示认可，并对与导航员的联系频率感到满意。艾滋病毒污名化是护理障碍的主要驱动因素。导航员通过教育以及示范如何成功地与艾滋病毒共存，帮助患者克服羞耻感。他们通过帮助患者向信任的人透露病情来消除对歧视的恐惧。这些行动反过来促进了患者对护理的参与、抗逆转录病毒疗法的依从性以及艾滋病毒预防工作。研究结果表明，同伴导航是一种可行的方法，有可能最大限度地提高基于抗逆转录病毒疗法的艾滋病毒治疗和预防策略的影响。
