Médecins Sans Frontières South Africa, Cape Town, South Africa
Médecins Sans Frontières South Africa, Cape Town, South Africa.
BMJ Open. 2020 Jul 8;10(7):e037545. doi: 10.1136/bmjopen-2020-037545.
Longer intervals between routine clinic visits and medication refills are part of patient-centred, differentiated service delivery (DSD). They have been shown to improve patient outcomes as well as optimise health services-vital as 'universal test-and-treat' targets increase numbers of HIV patients on antiretroviral treatment (ART). This qualitative study explored patient, healthcare worker and key informant experiences and perceptions of extending ART refills to 6 months in adherence clubs in Khayelitsha, South Africa.
In-depth interviews were conducted in isiXhosa with purposively selected patients and in English with healthcare workers and key informants. All transcripts were audio-recorded, transcribed and translated to English, manually coded and thematically analysed. The participants had been involved in a randomised controlled trial evaluating multi-month ART dispensing in adherence clubs, comparing 6-month and 2-month refills.
Twenty-three patients, seven healthcare workers and six key informants.
Patients found that 6-month refills increased convenience and reduced unintended disclosure. Contrary to key informant concerns about patients' responsibility to manage larger quantities of ART, patients receiving 6-month refills were highly motivated and did not face challenges transporting, storing or adhering to treatment. All participant groups suggested that strict eligibility criteria were necessary for patients to realise the benefits of extended dispensing intervals. Six-month refills were felt to increase health system efficiency, but there were concerns about whether the existing drug supply system could adapt to 6-month refills on a larger scale.
Patients, healthcare workers and key informants found 6-month refills within adherence clubs acceptable and beneficial, but concerns were raised about the reliability of the supply chain to manage extended multi-month dispensing. Stepwise, slow expansion could avoid overstressing supply and allow time for the health system to adapt, permitting 6-month ART refills to enhance current DSD options to be more efficient and patient-centred within current health system constraints.
常规门诊就诊和药物续配之间的间隔时间更长是以人为本、差异化服务提供（DSD）的一部分。已经证明，它们可以改善患者的预后，优化卫生服务，因为“普遍检测和治疗”目标增加了接受抗逆转录病毒治疗（ART）的艾滋病毒患者数量。这项定性研究探讨了在南非开普敦的遵医俱乐部中，将抗逆转录病毒药物续配延长至 6 个月时患者、医疗保健工作者和关键信息者的经验和看法。
用 isiXhosa 对患者进行了深入访谈，对医疗保健工作者和关键信息者进行了英语访谈。所有的转录都被录音、转录和翻译为英语，手动编码并进行主题分析。这些参与者参与了一项评估在遵医俱乐部中进行多月份抗逆转录病毒药物配给的随机对照试验，比较了 6 个月和 2 个月的续配。
23 名患者、7 名医疗保健工作者和 6 名关键信息者。
患者发现 6 个月的续配增加了便利性，减少了意外的披露。与关键信息者对患者管理更大数量的 ART 的责任的担忧相反，接受 6 个月续配的患者非常有动力，没有面临运输、储存或坚持治疗的挑战。所有参与者群体都认为，为了使患者从延长的配药间隔中受益，严格的资格标准是必要的。6 个月的续配被认为提高了卫生系统的效率，但有人担心现有的药品供应系统能否适应更大规模的 6 个月续配。
患者、医疗保健工作者和关键信息者认为在遵医俱乐部中进行 6 个月的续配是可以接受和有益的，但对供应链的可靠性表示担忧，以管理延长的多月份配药。逐步、缓慢地扩大规模可以避免过度紧张供应，并为卫生系统适应留出时间，使 6 个月的抗逆转录病毒药物续配能够在当前卫生系统的限制下，提高当前的 DSD 选择，更有效率和以患者为中心。
