University of Minnesota, Division of Infectious Diseases and International Medicine, Department of Medicine, Minneapolis, MN, USA.
Infectious Diseases Institute, Makerere University, Kampala, Uganda.
AIDS Care. 2022 May;34(5):597-605. doi: 10.1080/09540121.2021.1946000. Epub 2021 Jul 27.
Achieving universal HIV test-and-treat will require targeted interventions for those with worse outcomes, including advanced HIV. We conducted qualitative, semi-structured interviews with healthcare workers (HCWs) and people living with HIV (PLWH) at 5 HIV clinics in Kampala, Uganda, to understand barriers to care. PLWH enrolled started/restarted on HIV treatment ≤3 months prior. PLWH were grouped as 1) "ART-experienced" or those restarted therapy after ≥12 months off, 2) ART naïve CD4 count <100 cells/uL "late presenters" or 3) ART naïve CD4 count >350 cells/uL "early presenters". In-depth interviews were conducted in Luganda, translated, and transcribed verbatim. Between May and August 2017, 58 PLWH and 20 HCWs were interviewed. High stigma and low social support emerged as themes among all as barriers to care. Alcohol abuse was a barrier for men. Fear of domestic violence and abandonment were barriers for women, limiting disclosure of their HIV status to their male partners. Clinic factors such as rapport with staff, distance, efficiency, and privacy impacted care. Future interventions to decrease delayed ART initiation should target stigma and social support. Assisted disclosure, contact tracing, and alcohol abuse treatment should be implemented. Strengthening client support, reducing wait times, and increasing privacy assurances would improve care-seeking behaviors.
实现普遍的艾滋病毒检测和治疗将需要针对那些结局较差的人（包括艾滋病毒晚期患者）采取有针对性的干预措施。我们在乌干达坎帕拉的 5 家艾滋病毒诊所对医护人员（HCWs）和艾滋病毒感染者（PLWH）进行了定性、半结构化访谈，以了解护理障碍。入组的 PLWH 在 ≤3 个月前开始/重新开始接受艾滋病毒治疗。PLWH 分为 1）“ART 经验丰富”或那些在停药 ≥12 个月后重新开始治疗的人，2）ART 初治 CD4 计数<100 个/uL 的“晚期出现者”，或 3）ART 初治 CD4 计数>350 个/uL 的“早期出现者”。在 2017 年 5 月至 8 月期间，对 58 名 PLWH 和 20 名 HCWs 进行了深入访谈。在所有参与者中，高污名化和低社会支持是护理障碍的主题。酗酒是男性的障碍。对家庭暴力和被抛弃的恐惧是女性的障碍，限制了她们向男性伴侣透露艾滋病毒状况。诊所因素，如与工作人员的关系、距离、效率和隐私，也会影响护理。未来减少延迟开始抗逆转录病毒治疗的干预措施应针对污名和社会支持。应实施辅助披露、接触者追踪和酗酒治疗。加强客户支持、减少等待时间和增加隐私保证将改善寻求护理的行为。
