Mulqueeny Delarise M, Taylor Myra
School of Nursing and Public Health, University of KwaZulu-Natal, South Africa.
South Afr J HIV Med. 2017 Mar 31;18(1):677. doi: 10.4102/sajhivmed.v18i1.677. eCollection 2017.
The South African antiretroviral therapy (ART) programme, which is in its second decade of existence, includes many successes and challenges. This study provides patients' recommendations to address the challenges they currently experience at four antiretroviral (ARV) clinics based in urban public hospitals in order to provide a patient-centred service.
To use patients' recommendations to develop intervention strategies to improve patients' experiences of the public ART programme.
A three-stage, sequential, mixed-method study was implemented. Stage 1 recruited five patients from the four sites to formulate and test a structured questionnaire prior to data collection. Stage 2 recruited a stratified random sample of 400 patients (100 from each hospital) to complete the administered structured questionnaire. Stage 3 purposively selected 12 patients (three from each of the four sites) to participate in in-depth audio-recorded interviews using an interview schedule.
The 412 patients prioritised six recommendations, which are as follows: waiting areas should be enclosed to protect patients from the elements (rain, sun, lightening, wind and cold); patients should not have to return their files to the main hospital or ARV clinic themselves; stable patients should collect their ARV drugs every three months; pharmacy opening and closing times should be revised to suit patients' needs; HIV-positive patient representatives should be elected at each ARV clinic to address patients' concerns and/or challenges to ensure that the programme could be more patient-centred and ARV clinic operating times should be extended to open later during weekdays and over weekends.
Patients living with HIV have a valuable contribution to make in assessing service delivery and making recommendations to create a patient-centred healthcare environment, which will feasibly increase their adherence to ART.
南非抗逆转录病毒疗法（ART）项目已开展了二十年，取得了诸多成功，但也面临不少挑战。本研究收集了患者的建议，以应对他们目前在城市公立医院的四家抗逆转录病毒（ARV）诊所所遇到的挑战，从而提供以患者为中心的服务。
利用患者的建议制定干预策略，以改善患者在公共抗逆转录病毒疗法项目中的体验。
实施了一项三阶段、循序渐进的混合方法研究。第一阶段从四个地点招募了五名患者，在数据收集之前制定并测试一份结构化问卷。第二阶段招募了400名患者的分层随机样本（每家医院100名），以完成所发放的结构化问卷。第三阶段有目的地选取了12名患者（四个地点各三名），使用访谈提纲参与深度录音访谈。
412名患者将六项建议列为优先事项，具体如下：候诊区应封闭，以保护患者免受恶劣天气影响（如雨、阳光、闪电、风和寒冷）；患者不应自行将病历返回主医院或抗逆转录病毒诊所；病情稳定的患者应每三个月领取一次抗逆转录病毒药物；药房的营业时间应根据患者需求进行调整；每家抗逆转录病毒诊所应选举艾滋病毒阳性患者代表，以解决患者的关切和/或挑战，确保该项目能更以患者为中心；抗逆转录病毒诊所的营业时间应延长，在工作日延迟开门并在周末营业。
艾滋病毒感染者在评估服务提供情况并提出建议以营造以患者为中心的医疗环境方面能做出宝贵贡献，这有望提高他们对抗逆转录病毒疗法的依从性。
