Tshuma Ndumiso, Mosikare Ofentse, Yun Jessica A, Alaba Olufunke A, Maheedhariah Meera S, Muloongo Keith, Nyasulu Peter S
Community AIDS Response, Johannesburg, South Africa.
School of Health Sciences, Monash University South Africa, Johannesburg, South Africa.
Patient Prefer Adherence. 2017 Sep 11;11:1523-1531. doi: 10.2147/PPA.S116826. eCollection 2017.
Patient retention in care for HIV/AIDS is a critical challenge for antiretroviral treatment programs. Community-based adherence programs (CBAPs) as compared to health care facility-based adherence programs have been considered as one of the options to provide treatment maintenance support for groups of patients on antiretroviral therapy. Such an approach provides a way of enhancing self-management of the patient's condition. In addition, CBAPs have been implemented to support antiretroviral treatment expansion in resource-limited settings. CBAPs involve 30 patients that are allocated to a group and meet at either a facility or a community venue for less than an hour every 2 or 3 months depending on the supply of medication. Our study aimed to establish perceived challenges in moving adherence clubs from health facilities to communities.
A qualitative study was conducted in 39 clinics in Mpumalanga and Gauteng Provinces in South Africa between December 2015 and January 2016. Purposive sampling method was used to identify nurses, club managers, data capturers, pharmacists and pharmacy assistants who had been involved in facility-based treatment adherence clubs. Key-informant interviews were conducted. Also, semi-structured interviews were used and thematic content analysis was done.
A total of 53 health care workers, 12 (22.6%) males and 41 (77.4%) females, participated in the study. Most of them 49 (92.5%) indicated that participating in community adherence clubs were a good idea. Reduction in waiting time at the health facilities, in defaulter rate, improvement in adherence to treatment as well as reduction in stigma were some of the perceived benefits. However, security of medication, storage conditions and transportation of the prepacked medication to the distribution sites were the areas of concern.
Health care workers were agreeable to idea of the moving adherence clubs from health facilities to communities. Although some challenges were identified, these could be addressed by the key stakeholders. However, government and nongovernmental organizations need to exercise caution when transitioning to community-based adherence clubs.
对于抗逆转录病毒治疗项目而言，让感染艾滋病毒/艾滋病的患者持续接受治疗是一项严峻挑战。与基于医疗机构的依从性项目相比，基于社区的依从性项目（CBAPs）被视为为接受抗逆转录病毒治疗的患者群体提供治疗维持支持的选择之一。这种方法为增强患者病情的自我管理提供了一条途径。此外，已实施CBAPs以支持在资源有限的环境中扩大抗逆转录病毒治疗。CBAPs涉及30名患者，他们被分成一组，根据药物供应情况，每2或3个月在医疗机构或社区场所会面不到一小时。我们的研究旨在确定将依从性俱乐部从医疗机构转移到社区过程中所察觉到的挑战。
2015年12月至2016年1月期间，在南非姆普马兰加省和豪登省的39家诊所进行了一项定性研究。采用目的抽样法确定参与基于医疗机构的治疗依从性俱乐部的护士、俱乐部管理人员、数据记录员、药剂师和药房助理。进行了关键 informant访谈。此外，还采用了半结构化访谈并进行了主题内容分析。
共有53名医护人员参与了研究，其中12名（22.6%）为男性，41名（77.4%）为女性。他们中的大多数49名（92.5%）表示参与社区依从性俱乐部是个好主意。在医疗机构等待时间的减少、失访率的降低、治疗依从性的提高以及耻辱感的减轻是一些被察觉到的益处。然而，药物的安全性、储存条件以及预包装药物运输到分发地点是令人担忧的领域。
医护人员赞同将依从性俱乐部从医疗机构转移到社区的想法。尽管发现了一些挑战，但关键利益相关者可以解决这些问题。然而，政府和非政府组织在向基于社区的依从性俱乐部过渡时需要谨慎行事。
