Division of HIV, ID and Global Medicine, University of California San Francisco, San Francisco, California, United States of America.
Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America.
PLoS One. 2019 Jan 23;14(1):e0210126. doi: 10.1371/journal.pone.0210126. eCollection 2019.
Previous research indicates clinical outcomes among HIV-infected men in sub-Saharan Africa are sub-optimal. The SEARCH test and treat trial (NCT01864603) intervention included antiretroviral care delivery designed to address known barriers to HIV-care among men by decreasing clinic visit frequency and providing flexible, patient-centered care with retention support. We sought to understand facilitators and barriers to retention in care in this universal treatment setting through quantitative and qualitative data analysis.
We used a convergent mixed methods study design to evaluate retention in HIV care among adults (age > = 15) during the first year of the SEARCH (NCT01864603) test and treat trial. Cox proportional hazards regression was used to evaluate predictors of retention in care. Longitudinal qualitative data from n = 190 in-depth interviews with HIV-positive individuals and health care providers were analyzed to identify facilitators and barriers to HIV care engagement.
There were 1,863 men and 3,820 women who linked to care following baseline testing. Retention in care was 89.7% (95% CI 87.0-91.8%) among men and 89.0% (86.8-90.9%) among women at one year. In both men and women older age was associated with higher rates of retention in care at one year. Additionally, among men higher CD4+ at ART initiation and decreased time between testing and ART initiation was associated with higher rates of retention. Maintaining physical health, a patient-centered treatment environment, supportive partnerships, few negative consequences to disclosure, and the ability to seek care in facilities outside of their community of residence were found to promote retention in care.
Features of the ART delivery system in the SEARCH intervention and social and structural advantages emerged as facilitators to retention in HIV care among men. Messaging around the health benefits of early ART start, decreasing logistical barriers to HIV care, support of flexible treatment environments, and accelerated linkage to care, are important to men's success in ART treatment programs. Men already benefit from increased social support following disclosure of their HIV-status. Future efforts to shift gender norms towards greater equity are a potential strategy to support high levels of engagement in care for both men and women.
先前的研究表明，撒哈拉以南非洲地区感染艾滋病毒的男性的临床治疗效果并不理想。SEARCH 测试和治疗试验（NCT01864603）干预措施包括提供抗逆转录病毒护理服务，旨在通过减少就诊次数并提供灵活、以患者为中心的护理以及保留支持，解决男性接受艾滋病毒护理方面的已知障碍。我们试图通过定量和定性数据分析，了解在这种普遍治疗环境中保留护理的促进因素和障碍。
我们使用了一种收敛混合方法研究设计，来评估在 SEARCH（NCT01864603）测试和治疗试验的第一年期间，成年（年龄≥15 岁）人群的艾滋病毒护理保留情况。使用 Cox 比例风险回归来评估保留护理的预测因素。对 190 名艾滋病毒阳性个体和卫生保健提供者的深入访谈进行了纵向定性数据分析，以确定艾滋病毒护理参与的促进因素和障碍。
基线检测后，有 1863 名男性和 3820 名女性与护理机构建立了联系。男性的护理保留率为 89.7%（95%CI 87.0-91.8%），女性为 89.0%（86.8-90.9%），在一年时。在男性和女性中，年龄较大与一年时更高的保留率相关。此外，在男性中，较高的 CD4+在开始 ART 时和减少检测与开始 ART 之间的时间与更高的保留率相关。保持身体健康、以患者为中心的治疗环境、支持性的伙伴关系、较少的披露负面后果以及能够在社区外的医疗机构寻求护理，这些都被发现可以促进艾滋病毒护理的保留。
SEARCH 干预措施中的抗逆转录病毒治疗提供系统的特征和社会结构优势，这些都成为了男性保留艾滋病毒护理的促进因素。围绕早期开始 ART 的健康益处、减少艾滋病毒护理的后勤障碍、支持灵活的治疗环境以及加速护理联系的信息传递，对男性在 ART 治疗项目中的成功至关重要。男性在披露艾滋病毒状况后已经从增加的社会支持中受益。未来努力改变性别规范，实现更大的公平，可能是支持男性和女性高度参与护理的一项战略。
