Department of Family Medicine, University of Pretoria, Pretoria, South Africa.
Department of Immunology, University of Pretoria, Pretoria, South Africa.
PLoS One. 2020 Oct 15;15(10):e0240740. doi: 10.1371/journal.pone.0240740. eCollection 2020.
Little is known about the barriers and benefits of home-based HIV services offered by community health workers. These are especially important as the South African government embarks on scaling up community-based health services, which include HIV care. This study set out to understand potential benefits and barriers of these services in Tshwane district and develop recommendations for improvement. From June to August 2019, seven focus group discussions were conducted with 58 participants: four with 36 ward-based outreach team (WBOT) members and three with 22 people living with HIV (PLWHIV). Three aspects of care were explored: 1. Experience of performing, receiving or observing home-based HIV care; 2. Barriers to conducting home visits; and 3. The perceived value of WBOTs and home-based HIV care. While home-based HIV care was seen as a support strategy which could motivate patients to take their medication, the unpredictability of patients' responses to HIV test results, incorrect addresses (driven by the need for identity documents), fear of stigma through association with WBOTs, especially those in uniform, little or no preparation of patients for home-based care, and lack of confidentiality and trust were raised as potential barriers. To successfully implement effective home-based HIV care in South Africa, perceived barriers should be addressed and recommendations offered by people providing and receiving these services should be seriously considered. Pertinent recommendations include integrating WBOTs into clinics and existing support structures, improving training on confidentiality and HIV testing, and rethinking the recruitment, scope of work and safety of WBOTs. In addition, research should be conducted into the impact of the requirements for identity documents and community health worker uniforms.
社区卫生工作者提供的家庭艾滋病服务的障碍和益处知之甚少。随着南非政府着手扩大包括艾滋病护理在内的基于社区的卫生服务，这些服务显得尤为重要。本研究旨在了解茨瓦尼地区这些服务的潜在益处和障碍，并提出改进建议。2019 年 6 月至 8 月，与 58 名参与者进行了 7 次焦点小组讨论：4 次与 36 名基层外展工作队（WBOT）成员进行，3 次与 22 名艾滋病毒感染者（PLHIV）进行。探讨了三个方面的护理：1. 进行、接受或观察家庭艾滋病护理的经验；2. 进行家访的障碍；3. WBOT 和家庭艾滋病护理的感知价值。虽然家庭艾滋病护理被视为一种支持策略，可以激励患者服用药物，但患者对艾滋病检测结果的反应不可预测、地址不正确（受身份证需求驱动）、害怕因与 WBOT 有关联而受到污名化，特别是那些穿制服的、对家庭护理准备不足、缺乏保密性和信任，这些都被认为是潜在的障碍。为了在南非成功实施有效的家庭艾滋病护理，应解决人们认为的障碍，并认真考虑提供和接受这些服务的人提出的建议。相关建议包括将 WBOT 整合到诊所和现有的支持结构中，提高保密性和艾滋病检测方面的培训，重新思考 WBOT 的招聘、工作范围和安全性。此外，还应研究身份证要求和社区卫生工作者制服对社区的影响。
