“在这个[]俱乐部，我们现在是一家人了”：南非抗逆转录病毒治疗依从性俱乐部的一个现实主义理论检验案例研究。

'At this [] club, we are a family now': A realist theory-testing case study of the antiretroviral treatment adherence club, South Africa.

作者信息

Mukumbang Ferdinand C, van Wyk Brian, Van Belle Sara, Marchal Bruno

机构信息

School of Public Health, University of the Western Cape, Cape Town, South Africa.

Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.

出版信息

South Afr J HIV Med. 2019 Jun 26;20(1):922. doi: 10.4102/sajhivmed.v20i1.922. eCollection 2019.

DOI:10.4102/sajhivmed.v20i1.922

PMID:31308968

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6620516/

Abstract

BACKGROUND

An estimated 7.9 million people were living with HIV in South Africa in 2017, with 63.3% of them remaining in antiretroviral therapy (ART) care and 62.9% accessing ART. Poor retention in care and suboptimal adherence to ART undermine the successful efforts of initiating people living with HIV on ART. To address these challenges, the antiretroviral adherence club intervention was designed to streamline ART services to 'stable' patients. Nevertheless, it is poorly understood exactly how and why and under what health system conditions the adherence club intervention works.

OBJECTIVES

The aim of this study was to test a theory on how and why the adherence club intervention works and in what health system context(s) in a primary healthcare facility in the Western Cape Province.

METHOD

Within the realist evaluation framework, we applied a confirmatory theory-testing case study approach. Kaplan-Meier descriptions were used to estimate the rates of dropout from the adherence club intervention and virological failure as the principal outcomes of the adherence club intervention. Qualitative interviews and non-participant observations were used to explore the context and identify the mechanisms that perpetuate the observed outcomes or behaviours of the actors. Following the retroduction logic of making inferences, we configured information obtained from quantitative and qualitative approaches using the intervention-context-actor-mechanism-outcome heuristic tool to formulate generative theories.

RESULTS

We confirmed that patients on ART in adherence clubs will continue to adhere to their medication and remain in care because their self-efficacy is improved; they are motivated or are being nudged.

CONCLUSION

A theory-based understanding provides valuable lessons towards the adaptive implementation of the adherence club intervention.

摘要

背景

2017年，估计有790万南非人感染了艾滋病毒，其中63.3%的人继续接受抗逆转录病毒疗法（ART）治疗，62.9%的人接受了ART治疗。护理留存率低以及对ART的依从性欠佳，破坏了让艾滋病毒感染者开始接受ART治疗的成功努力。为应对这些挑战，设计了抗逆转录病毒依从性俱乐部干预措施，以使ART服务更精简地提供给“稳定”患者。然而，对于依从性俱乐部干预措施如何、为何以及在何种卫生系统条件下起作用，人们知之甚少。

目的

本研究的目的是在西开普省的一家初级医疗保健机构中，检验一种关于依从性俱乐部干预措施如何、为何起作用以及在何种卫生系统背景下起作用的理论。

方法

在现实主义评价框架内，我们采用了一种验证性理论检验案例研究方法。使用Kaplan-Meier描述来估计依从性俱乐部干预措施的退出率和病毒学失败率，将其作为依从性俱乐部干预措施的主要结果。采用定性访谈和非参与观察来探索背景情况，并确定使观察到的行为者结果或行为持续存在的机制。遵循进行推理的溯因逻辑，我们使用干预-背景-行为者-机制-结果启发式工具，对从定量和定性方法中获得的信息进行配置，以形成生成性理论。