尼日利亚关键人群对使用公共卫生和同伴主导的艾滋病毒预防服务设施的满意度。
Satisfaction with use of public health and peer-led facilities for HIV prevention services by key populations in Nigeria.
机构信息
Heartland Alliance International, Abuja, Nigeria.
New HIV Vaccine and Microbicide Advocacy Society, Lagos, Nigeria.
出版信息
BMC Health Serv Res. 2019 Nov 21;19(1):856. doi: 10.1186/s12913-019-4691-z.
BACKGROUND
The aim of the study was to identify the proportion of female sex workers, men who have sex with men, and people who inject drugs who had accessed HIV prevention services at public health facilities and peer-led facilities, their level of satisfaction with these services, and perceived barriers and challenges to accessing HIV services from public and peer-led HIV prevention service providers.
METHODS
A mixed-method approach was used to collect data from key populations in the four states in Nigeria. Quantitative data collected included level of satisfaction with and barriers to use of public and peer-led facilities. In-depth interviews and focus-group discussions were conducted to explore reasons for satisfaction with and barriers to use of services. Descriptive and bivariate analyses were was conducted for quantitative data. Qualitative data were summaried, emerging themes identified, described and quotes reflecting the themes corresponding to interview questions highlighted.
RESULTS
Nine hundred sixty-seven persons responded to questions on the use of public health or/and peer-led facilities. Two hundred thirty-eight (49.4%) respondents had received HIV and sexual and reproductive health services through public health facilities, and 236 (48.7%) had received the services through peer-led facilities. Significantly more respondents were satisfied with the quality of services provided by peer-led organisations than with public health facilities with respect to service providers listening to respondent's problems and concerns (p = 0.007),privacy and confidentiality (p = 0.04) and respect of rights of service recipients (p = 0.04). Significantly more respondents using peer-led organisations than those using public health facilities identified no barriers to service access (p = 0.003). More respondents using public health facilities than peer-led facilities identified cost of services (p = 0.01), confidentiality (p = 0.002), waiting time (p < 0.01) and staff attitude (p = 0.001) as barriers to service access. Thee was no difference in the proportion of respondents willing to discontinue their use of either facilities (p = 0.08). Qualitative data revealed that concerns with access of services at the public health facility were due mainly to stigma and the effects of the same-sex prohibition law.
CONCLUSION
Key populations were more satisfied receiving HIV prevention services at peer-led organisations than at public health facilities.
背景
本研究旨在确定在尼日利亚四个州的男男性行为者、女性性工作者和注射毒品者中，有多少人在公共卫生机构和同伴主导的机构中获得了艾滋病毒预防服务，他们对这些服务的满意度如何，以及他们认为从公共和同伴主导的艾滋病毒预防服务提供者那里获得艾滋病毒服务的障碍和挑战是什么。
方法
采用混合方法从尼日利亚四个州的重点人群中收集数据。定量数据包括对公共和同伴主导设施的使用满意度和障碍。进行了深入访谈和焦点小组讨论，以探讨对服务的满意度和障碍的原因。对定量数据进行了描述性和双变量分析。定性数据进行了总结，确定了出现的主题，描述了反映与访谈问题相对应的主题的引述。
结果
967 人回答了关于使用公共卫生或/和同伴主导设施的问题。238 人（49.4%）通过公共卫生设施接受了艾滋病毒和性健康服务，236 人（48.7%）通过同伴主导的设施接受了服务。与公共卫生设施相比，受访者对同伴主导组织提供的服务质量更满意，服务提供者倾听受访者的问题和关注点（p=0.007）、隐私和保密性（p=0.04）和尊重服务接受者的权利（p=0.04）。使用同伴主导组织的受访者比使用公共卫生设施的受访者表示没有服务获取障碍（p=0.003）。与使用公共卫生设施的受访者相比，使用同伴主导设施的受访者表示没有服务获取障碍（p=0.003）。与使用公共卫生设施的受访者相比，使用同伴主导设施的受访者表示没有服务获取障碍（p=0.003）。与使用公共卫生设施的受访者相比，使用同伴主导设施的受访者表示没有服务获取障碍（p=0.003）。与使用公共卫生设施的受访者相比，使用同伴主导设施的受访者表示没有服务获取障碍（p=0.003）。更多的受访者认为服务费用（p=0.01）、保密性（p=0.002）、等待时间（p<0.01）和员工态度（p=0.001）是服务获取的障碍。愿意停止使用任何设施的受访者比例没有差异（p=0.08）。定性数据显示，对公共卫生设施获得服务的关注主要是由于耻辱感和同性禁止法的影响。
结论
重点人群在同伴主导的组织中接受艾滋病毒预防服务的满意度高于在公共卫生机构。
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