The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America.
University of Minnesota, School of Public Health, Minneapolis, MN, United States of America.
PLoS One. 2020 May 29;15(5):e0232841. doi: 10.1371/journal.pone.0232841. eCollection 2020.
Eswatini (formerly Swaziland) has one of the highest rates of TB and HIV co-disease in the world. Despite national efforts to improve service delivery and prevent TB and HIV transmission, rates remain high. A recent prospective, observational study of integrated, patient-selected IPT delivery showed extraordinary improvements in IPT adherence, running counter to previous assumptions. This prompted the need to understand contextual and unseen study factors that contributed to high rates of adherence.
To investigate high rates of IPT adherence rates among people living with HIV who participated in an observational study comparing modes of IPT delivery.
Community-based participatory research guided the development of in-person administration of semi-structured questionnaires. Observational and field note data were analyzed. Qualitative data were analyzed using content analysis.
We interviewed 150 participants and analyzed responses from the 136 who remembered being given a choice of their IPT delivery method. Fifty-seven percent were female and the median age was 42. Nearly 67% of participants chose to receive facility-based IPT. High rates of self-reported IPT treatment adherence were linked to four key concepts: 1) adherence was positively impacted by community education; 2) disclosure of status served to empower participant completion; 3) mode of delivery perceptions positively impacted adherence; and 4) choice of treatment delivery seen as helpful but not essential for treatment completion.
Achieving higher rates of IPT adherence in Eswatini and similar rural areas requires community-engaged education and outreach in coordination with care delivery systems.
斯威士兰（前称“斯威士兰王国”）是全世界结核病和艾滋病毒合并感染率最高的国家之一。尽管斯威士兰全国努力改善服务提供并预防结核病和艾滋病毒的传播，但感染率仍居高不下。最近一项关于综合、患者选择的 IPT 给药的前瞻性、观察性研究表明，IPT 依从性有了显著提高，这与之前的假设背道而驰。这促使人们需要了解促成高依从率的背景和未被观察到的研究因素。
调查参与一项观察性研究比较 IPT 给药方式的艾滋病毒感染者中 IPT 高依从率的原因。
社区参与式研究指导了面对面管理半结构化问卷的制定。对观察数据和实地记录数据进行了分析。采用内容分析法对定性数据进行了分析。
我们采访了 150 名参与者，并分析了 136 名记得有选择其 IPT 给药方式的参与者的回应。其中 57%为女性，中位数年龄为 42 岁。近 67%的参与者选择在医疗机构接受 IPT。高比例的自我报告 IPT 治疗依从性与四个关键概念相关：1）社区教育对依从性产生积极影响；2）公开身份有助于增强参与者完成治疗的能力；3）对给药模式的看法对依从性有积极影响；4）治疗提供方式被视为有助于完成治疗，但不是完成治疗的必要条件。
要在斯威士兰和类似农村地区实现更高的 IPT 依从率，需要社区参与的教育和外联，与护理提供系统相协调。
