Kiriazova Tetiana, Postnov Oleksandr, Bingham Trista, Myers Janet, Flanigan Timothy, Vitek Charles, Neduzhko Oleksandr
Ukrainian Institute on Public Health Policy, 4, Malopidvalna Street, Of.6, Kyiv, 01001, Ukraine.
Division of Global HIV and Tuberculosis, Centers for Global Health, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA.
BMC Health Serv Res. 2018 Jan 30;18(1):58. doi: 10.1186/s12913-018-2885-4.
Engagement with HIV medical care is critical to successful HIV treatment and prevention efforts. However, in Ukraine, delays in the timely initiation of HIV treatment hamper viral suppression. By January 01, 2016, only 126,604 (57.5%) of the estimated 220,000 people living with HIV (PLWH) had registered for HIV care, and most (55.1%) of those who registered for HIV care in 2015 did that at a late stage of infection. In the US, Anti-Retroviral Treatment and Access to Services (ARTAS) intervention successfully linked newly diagnosed PLWH to HIV services using strengths-based case management with a linkage coordinator. To tailor the ARTAS intervention for Ukraine, we conducted a qualitative study with patients and providers to understand barriers and facilitators that influence linkage to HIV care.
During September-October 2014, we conducted 20 in-depth interviews with HIV-positive patients and two focus groups with physicians in infectious disease, sexually transmitted infection (STI), and addiction clinics in Dnipropetrovsk Region of Ukraine. Interviews and focus groups were audio-recorded and transcribed verbatim. We translated illustrative quotes into English. We used thematic analysis for the data analysis.
Participants (20 patients and 14 physicians) identified multiple, mostly individual-level factors influencing HIV care initiation. Key barriers included lack of HIV knowledge, non-acceptance of HIV diagnosis, fear of HIV disclosure, lack of psychological support from health providers, and HIV stigma in community. Responsibility for one's health, health deterioration, and supportive provider communication were reported as facilitators to linkage to care. Expected benefits from the case management intervention included psychological support, HIV education, and help with navigating the segmented health system.
The findings from the study will be used to optimize the ARTAS for the Ukrainian context. Our findings can also support future linkage-to-care strategies in other countries of Eastern Europe and Central Asia.
参与艾滋病医疗护理对于成功开展艾滋病治疗和预防工作至关重要。然而，在乌克兰，艾滋病治疗的及时启动存在延误，这阻碍了病毒抑制。截至2016年1月1日，在估计的22万艾滋病病毒感染者（PLWH）中，只有126,604人（57.5%）登记接受艾滋病护理，并且在2015年登记接受艾滋病护理的人中，大多数（55.1%）是在感染后期才登记的。在美国，抗逆转录病毒治疗与服务获取（ARTAS）干预措施通过基于优势的个案管理以及一名联系协调员，成功地将新诊断的艾滋病病毒感染者与艾滋病服务联系起来。为了使ARTAS干预措施适用于乌克兰，我们对患者和医护人员进行了一项定性研究，以了解影响艾滋病护理联系的障碍和促进因素。
2014年9月至10月期间，我们在乌克兰第聂伯罗彼得罗夫斯克地区的传染病、性传播感染（STI）和成瘾诊所，对20名艾滋病病毒呈阳性的患者进行了深入访谈，并与医生进行了两个焦点小组讨论。访谈和焦点小组讨论进行了录音，并逐字转录。我们将具有代表性的引语翻译成了英语。我们使用主题分析法进行数据分析。
参与者（20名患者和14名医生）确定了多个主要影响艾滋病护理启动的个人层面因素。关键障碍包括缺乏艾滋病知识、不接受艾滋病诊断、害怕披露艾滋病病情、缺乏医护人员的心理支持以及社区中的艾滋病污名化现象。对自身健康的责任感、健康状况恶化以及医护人员的支持性沟通被报告为护理联系的促进因素。个案管理干预措施预期的益处包括心理支持、艾滋病教育以及在复杂的卫生系统中提供帮助。
该研究的结果将用于优化适用于乌克兰情况的ARTAS。我们的研究结果还可为东欧和中亚其他国家未来的护理联系策略提供支持。
