患者对将梅毒常规筛查与 HIV 病毒载量检测相结合的实施看法：增强 HIV 阳性男性梅毒筛查试验的定性过程评估。
Patient perspectives on the implementation of routinised syphilis screening with HIV viral load testing: Qualitative process evaluation of the Enhanced Syphilis Screening Among HIV-positive Men trial.
机构信息
School of Social Work, York University, 4700 Keele Street, M3J 1P3, Toronto, Ontario, Canada.
MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada.
出版信息
BMC Health Serv Res. 2021 Jun 30;21(1):625. doi: 10.1186/s12913-021-06602-1.
BACKGROUND
Syphilis infections have been on the rise, affecting men living with HIV in urban centres disproportionately. Since individuals in HIV care undergo routine blood testing, HIV clinics provide practical opportunities to conduct regular and frequent syphilis testing. Following the implementation of a routine syphilis testing intervention in HIV outpatient clinics, we conducted a qualitative process evaluation of patient experiences to measure patient acceptability, barriers to implementation, and facilitators of successful uptake.
METHODS
Upon completion of the trial, which took place at four HIV outpatient clinics in Toronto and Ottawa, Canada, we recruited male patients attending these clinics from November 2017 to April 2018. Interviews were conducted on-site and were audio-recorded and transcribed verbatim. All participants provided written informed consent. Interview data were analyzed using grounded theory, assessing qualitative modulators of effective uptake of routinised syphilis testing.
RESULTS
A total of 21 male patients were interviewed. Overall, interviewees found the clinical intervention acceptable, endorsing the practice of routinising syphilis testing alongside regular viral load bloodwork. Some men preferred, based on their self-assessment of syphilis risk, to opt out of testing; we considered this as a potential barrier to uptake of population-wide routinised syphilis testing. Interviewees also identified multiple facilitators of successful uptake, including the de-stigmatising of STI testing as a consequence of the universal nature of routinised testing. Participants recommended a routinised syphilis screening intervention to give patients peace of mind surrounding their sexual health. Participants identified HIV care clinics as comfortable and efficient locations to offer testing.
CONCLUSIONS
Overall, most men were in support of implementing routinised syphilis testing as part of standard HIV care. From the patient perspective, HIV care clinics are convenient places to be tested for syphilis, and the routine approach was viewed to have a de-stigmatisng effect on syphilis testing.
TRIAL REGISTRATION
ClinicalTrials.gov NCT02019043; registered December 23, 2013.
背景
梅毒感染呈上升趋势，在城市中心，感染艾滋病毒的男性受到的影响不成比例。由于接受艾滋病毒护理的个体要进行常规血液检测，因此艾滋病毒诊所为定期和频繁进行梅毒检测提供了切实可行的机会。在艾滋病毒门诊诊所实施常规梅毒检测干预措施后，我们对患者的体验进行了定性过程评估，以衡量患者的可接受性、实施障碍以及成功接受检测的促进因素。
方法
在加拿大多伦多和渥太华的四个艾滋病毒门诊诊所进行的试验完成后，我们于 2017 年 11 月至 2018 年 4 月招募了在这些诊所就诊的男性患者。在现场进行访谈，并对访谈进行音频记录和逐字转录。所有参与者均提供了书面知情同意书。使用扎根理论分析访谈数据，评估了有效接受常规梅毒检测的定性调节剂。
结果
共有 21 名男性患者接受了采访。总体而言，受访者认为临床干预措施是可以接受的，他们赞同在常规病毒载量血液检测的同时常规进行梅毒检测。一些男性根据自己对梅毒风险的评估，选择不接受检测；我们认为这是对普及常规梅毒检测接受率的潜在障碍。受访者还确定了成功接受检测的多个促进因素，包括由于常规检测的普遍性，性传播感染检测去污名化。参与者建议进行常规梅毒筛查干预，让患者对其性健康放心。参与者认为艾滋病毒护理诊所是提供检测的舒适和高效场所。
结论
总体而言，大多数男性支持将常规梅毒检测作为标准艾滋病毒护理的一部分。从患者的角度来看，艾滋病毒护理诊所是进行梅毒检测的方便场所，常规方法被认为对梅毒检测具有去污名化作用。
试验注册
ClinicalTrials.gov NCT02019043；注册日期 2013 年 12 月 23 日。
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