University of California Los Angeles, David Geffen School of Medicine, Division of Infectious Diseases, Los Angeles, CA, USA.
Partners in Hope Medical Center, Lilongwe, Malawi.
Glob Health Sci Pract. 2020 Mar 31;8(1):18-27. doi: 10.9745/GHSP-D-19-00286. Print 2020 Mar 30.
Multimonth dispensing (MMD) of antiretroviral therapy (ART) is a differentiated model of care that can help overcome health system challenges and reduce the burden of HIV care on clients. Although 3-month dispensing has been the standard of care, interest has increased in extending refill intervals to 6 months. We explored client and provider experiences with MMD in Malawi as part of a cluster randomized trial evaluating 3- versus 6-month ART dispensing.
Semi-structured in-depth interviews were conducted with 17 ART providers and 62 stable, adult clients with HIV on ART. Clients and providers were evenly divided by arm and were eligible for an interview if they had been participating in the study for 1 year (clients) or 6 months (providers). Questions focused on perceived challenges and benefits of the 3- or 6-month amount of ART dispensing. Interviews were transcribed, and data were coded and analyzed using constant comparison.
Both clients and providers reported that the larger medication supply had benefits. Clients reported decreased costs due to less frequent travel to the clinic and increased time for income-generating activities. Clients in the 6-month dispensing arm reported a greater sense of personal freedom and normalcy. Providers felt that the 6-month dispensing interval reduced their workload. They also expressed concerned about clients' challenges with ART storage at home, but clients reported no storage problems. Although providers mentioned the potential risk of clients sharing the larger medication supply with family or friends, clients emphasized the value of ART and reported only rare, short-term sharing, mostly with their spouses. Providers mentioned clients' lack of motivation to seek care for illnesses that might occur between refill appointments.
The 6-month ART dispensing arm was particularly beneficial to clients for decreased costs, increased time for income generation, and a greater sense of normalcy. Providers' concerns about storage, sharing, and return visits to the facility did not emerge in client interviews. Further data are needed on the feasibility of implementing a large-scale program with 6-month dispensing.
抗逆转录病毒疗法 (ART) 的多月配药 (MMD) 是一种差异化的护理模式，有助于克服卫生系统的挑战并减轻客户的 HIV 护理负担。虽然 3 个月的配药一直是护理标准，但人们对将续药间隔延长至 6 个月的兴趣有所增加。我们在马拉维进行了一项评估 3 个月与 6 个月 ART 配药的群组随机试验，其中探讨了 MMD 对客户和提供者的影响。
对 17 名 ART 提供者和 62 名稳定的、接受 ART 的成年 HIV 感染者进行了半结构化深入访谈。根据手臂的不同，客户和提供者平均分为两组，如果他们参加研究满 1 年（客户）或 6 个月（提供者），则有资格接受访谈。问题集中在对 3 个月或 6 个月 ART 配药量的感知挑战和益处。对访谈进行了转录，并使用常数比较对数据进行了编码和分析。
客户和提供者都报告说，更大的药物供应量有好处。客户报告说由于去诊所的频率降低以及有更多时间从事创收活动，成本降低。接受 6 个月配药的患者报告说个人自由度和正常感更强。提供者认为 6 个月的配药间隔减少了他们的工作量。他们还对患者在家中储存 ART 的挑战表示担忧，但患者报告没有储存问题。尽管提供者提到了患者与家人或朋友分享更大剂量药物的潜在风险，但患者强调了 ART 的价值，并报告说只有极少数短期分享，主要是与配偶分享。提供者提到了患者在续药预约之间因疾病而寻求护理的动力不足。
6 个月的 ART 配药对客户特别有益，因为可以降低成本、增加创收时间和提高正常感。提供者对储存、分享和返回医疗机构的担忧在患者访谈中并未出现。需要进一步的数据来评估实施大规模 6 个月配药计划的可行性。
