即时检测病毒载量以促进差异化护理的可接受性：对南非艾滋病病毒感染者和护士的定性评估
Acceptability of point-of-care viral load testing to facilitate differentiated care: a qualitative assessment of people living with HIV and nurses in South Africa.
作者信息
Msimango Lindani, Gibbs Andrew, Shozi Hlengiwe, Ngobese Hope, Humphries Hilton, Drain Paul K, Garrett Nigel, Dorward Jienchi
机构信息
Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.
出版信息
BMC Health Serv Res. 2020 Nov 25;20(1):1081. doi: 10.1186/s12913-020-05940-w.
BACKGROUND
Providing viral load (VL) results to people living with HIV (PLHIV) on antiretroviral therapy (ART) remains a challenge in low and middle-income countries. Point-of-care (POC) VL testing could improve ART monitoring and the quality and efficiency of differentiated models of HIV care. We assessed the acceptability of POC VL testing within a differentiated care model that involved task-shifting from professional nurses to less highly-trained enrolled nurses, and an option of collecting treatment from a community-based ART delivery programme.
METHODS
We undertook a qualitative sub-study amongst clients on ART and nurses within the STREAM study, a randomized controlled trial of POC VL testing and task-shifting in Durban, South Africa. Between March and August 2018, we conducted 33 semi-structured interviews with clients, professional and enrolled nurses and 4 focus group discussions with clients. Interviews and focus groups were audio recorded, transcribed, translated and thematically analysed.
RESULTS
Amongst 55 clients on ART (median age 31, 56% women) and 8 nurses (median age 39, 75% women), POC VL testing and task-shifting to enrolled nurses was acceptable. Both clients and providers reported that POC VL testing yielded practical benefits for PLHIV by reducing the number of clinic visits, saving time, travel costs and days off work. Receiving same-day POC VL results encouraged adherence amongst clients, by enabling them to see immediately if they were 'good' or 'bad' adherers and enabled quick referrals to a community-based ART delivery programme for those with viral suppression. However, there was some concern regarding the impact of POC VL testing on clinic flows when implemented in busy public-sector clinics. Regarding task-shifting, nurses felt that, with extra training, enrolled nurses could help decongest healthcare facilities by quickly issuing ART to stable clients. Clients could not easily distinguish enrolled nurses from professional nurses, instead they highlighted the importance of friendliness, respect and good communication between clients and nurses.
CONCLUSIONS
POC VL testing combined with task-shifting was acceptable to clients and healthcare providers. Implementation of POC VL testing and task shifting within differentiated care models may help achieve international treatment targets.
TRIAL REGISTRATION
NCT03066128 , registered 22/02/2017.
背景
在低收入和中等收入国家，向接受抗逆转录病毒治疗（ART）的艾滋病毒感染者（PLHIV）提供病毒载量（VL）检测结果仍然是一项挑战。即时检测（POC）VL检测可以改善ART监测以及艾滋病毒差异化护理模式的质量和效率。我们在一种差异化护理模式中评估了POC VL检测的可接受性，该模式涉及将任务从专业护士转移到培训程度较低的注册护士，并提供从社区ART服务项目领取治疗的选择。
方法
我们在STREAM研究中的接受ART治疗的患者和护士中进行了一项定性子研究，STREAM研究是在南非德班进行的一项关于POC VL检测和任务转移的随机对照试验。在2018年3月至8月期间，我们对患者、专业护士和注册护士进行了33次半结构化访谈，并与患者进行了4次焦点小组讨论。访谈和焦点小组进行了录音、转录、翻译和主题分析。
结果
在55名接受ART治疗的患者（中位年龄31岁，56%为女性）和8名护士（中位年龄39岁，75%为女性）中，POC VL检测和将任务转移给注册护士是可以接受的。患者和提供者都报告说，POC VL检测通过减少门诊次数、节省时间、交通成本和工作日天数，为PLHIV带来了实际好处。当日获得POC VL检测结果通过让患者能够立即知道自己是“依从性好”还是“依从性差”，鼓励了患者的依从性，并使病毒得到抑制的患者能够迅速转诊到社区ART服务项目。然而，对于在繁忙的公共部门诊所实施POC VL检测对门诊流程的影响存在一些担忧。关于任务转移，护士们认为，经过额外培训，注册护士可以通过快速为病情稳定的患者发放ART来帮助缓解医疗机构的拥堵。患者不容易区分注册护士和专业护士，相反，他们强调了患者与护士之间友好、尊重和良好沟通的重要性。
结论
POC VL检测与任务转移相结合为患者和医疗服务提供者所接受。在差异化护理模式中实施POC VL检测和任务转移可能有助于实现国际治疗目标。
试验注册
NCT03066128，于2017年2月22日注册。
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