艾滋病毒检测和咨询的经验：肯尼亚西部老年艾滋病毒感染者的定性研究。
HIV testing and counselling experiences: a qualitative study of older adults living with HIV in western Kenya.
机构信息
Moi University, College of Health Sciences, School of Medicine, Nandi Road, Eldoret, Kenya.
Academic Model Providing Access to Healthcare (AMPATH) Program, Moi Teaching and Referral Hospital Campus, Nandi Road, Eldoret, Kenya.
出版信息
BMC Geriatr. 2018 Oct 25;18(1):257. doi: 10.1186/s12877-018-0941-x.
BACKGROUND
Finding HIV infected persons and engaging them in care is crucial in achieving UNAIDS 90-90-90 targets; diagnosing 90% of those infected with HIV, initiating 90% of the diagnosed on ART and achieving viral suppression in 90% of those on ART. To achieve the first target, no person should be left behind in their access to HIV testing services. In Kenya, HIV prevention and testing services give less emphasis on older adults. This article describes HIV testing experiences of older adults living with HIV and how their age shaped their interaction and treatment received during HIV testing and diagnosis.
METHODS
We conducted a qualitative study in two HIV clinics (rural and urban) in western Kenya, and recruited 57 HIV infected persons aged ≥50 years. We conducted in depth interviews (IDIs) with 25 participants and 4 focus group discussions (FGDs) with a total of 32 participants and audio recorded all the sessions. Participants recruited were aged between 54 and 79 years with 43% being females. We transcribed audio records and analyzed the data using thematic content analysis method.
RESULTS
Older persons' experiences with HIV testing depended on where they tested (hospital or community setting); whether they actively sought the testing or not; and the age and gender of the healthcare provider who conducted the test. Participants expressed concerns with ageist discrimination when actively seeking HIV care testing services in hospital settings, characterized by providers' reluctance or refusal to test. The testing and counseling sessions were described as short and hurried within the hospital settings, whereas the interactions with service providers in home-based testing were experienced as appropriate and supportive. Participants in this study expressed preference for healthcare providers who were older and of similar gender.
CONCLUSION
HIV testing services are still not tailored to target older adults' needs in our setting resulting in late diagnosis among older persons. We argue that a scale-up of community level testing services that provide adequate testing and counselling time and actively reach out to older adults is key to attaining the UNAIDS targets of having 90% of PLWH know their status.
背景
发现 HIV 感染者并使其接受治疗对于实现 UNAIDS 90-90-90 目标至关重要；诊断出 90%的 HIV 感染者，使 90%已诊断出的感染者开始接受抗逆转录病毒治疗（ART），并使接受 ART 的 90%感染者病毒得到抑制。为了实现第一个目标，任何人都不应在获得 HIV 检测服务方面落后。在肯尼亚，HIV 预防和检测服务对老年人的重视程度较低。本文描述了老年 HIV 感染者的 HIV 检测体验，以及他们的年龄如何影响他们在 HIV 检测和诊断过程中的互动和接受的治疗。
方法
我们在肯尼亚西部的两家 HIV 诊所（农村和城市）进行了一项定性研究，招募了 57 名年龄≥50 岁的 HIV 感染者。我们对 25 名参与者进行了深入访谈（IDIs），对 32 名参与者进行了 4 次焦点小组讨论（FGDs），并对所有会议进行了录音。参与者的年龄在 54 至 79 岁之间，其中 43%为女性。我们对音频记录进行了转录，并使用主题内容分析方法对数据进行了分析。
结果
老年人的 HIV 检测体验取决于他们在哪里接受检测（医院或社区环境）；他们是否主动寻求检测；以及进行检测的医护人员的年龄和性别。参与者表示，在医院环境中主动寻求 HIV 护理检测服务时，存在年龄歧视问题，表现为提供者不愿意或拒绝进行检测。在医院环境中，检测和咨询过程被描述为短暂而匆忙，而在家庭检测中与服务提供者的互动则被认为是适当和支持的。本研究的参与者表示更喜欢年龄较大且性别相同的医护人员。
结论
在我们的环境中，HIV 检测服务仍然没有针对老年人的需求进行调整，导致老年人的诊断较晚。我们认为，扩大社区层面的检测服务，提供充足的检测和咨询时间，并积极接触老年人，是实现 UNAIDS 90%PLWH 知晓自身状况目标的关键。
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