Department of Health and Behavioral Sciences, University of Colorado Denver, Campus Box 188, P.O. Box 173364, Denver, CO, 80217-3364, USA.
Partners in Hope Medical Center, Lilongwe, Malawi.
AIDS Behav. 2022 Mar;26(3):674-685. doi: 10.1007/s10461-021-03427-1. Epub 2021 Aug 17.
Retention in antiretroviral therapy (ART) services is critical to achieving positive health outcomes for individuals living with HIV, but accumulating evidence indicates that individuals are likely to miss ART appointments over time. Thus, it is important to understand why individuals miss appointments and how they re-engage in HIV care. We used in-depth interviews with 44 ART clients in Malawi who recently missed an ART appointment (> 14 days) but eventually re-engaged in care (within 60 days) to explore reasons for missed appointments and barriers and facilitators to re-engagement. We found that most individuals missed ART appointments due to unexpected life events such as funerals, work, and illness for both clients and their treatment guardians who were also unable to attend facilities. Several reasons differed by gender-work-related travel was common for men, while caring for sick family members was common for women. Barriers to re-engagement included continued travel, illness, and restricted clinic schedules and/or staff shortages that led to repeat facility visits before being able to re-engage in care. Strong internal motivation combined with social support and reminders from community health workers facilitated re-engagement in HIV care.
抗逆转录病毒疗法 (ART) 服务的保留对于实现 HIV 感染者的积极健康结果至关重要，但越来越多的证据表明，个体随着时间的推移可能会错过 ART 预约。因此，了解个体错过预约的原因以及他们如何重新参与 HIV 护理非常重要。我们使用深入访谈的方法，对马拉维的 44 名最近错过 ART 预约（>14 天）但最终重新参与护理（在 60 天内）的 ART 患者进行了访谈，以探讨错过预约的原因以及重新参与护理的障碍和促进因素。我们发现，大多数个体错过 ART 预约是因为意外的生活事件，如葬礼、工作和客户及其治疗监护人的疾病，他们也无法前往医疗机构。一些原因因性别而异——男性常见的是因工作相关的旅行，而女性常见的是照顾生病的家庭成员。重新参与的障碍包括持续的旅行、疾病以及诊所时间表受限和/或工作人员短缺，导致在重新参与护理之前需要多次前往医疗机构。强烈的内在动机，加上来自社区卫生工作者的社会支持和提醒，促进了 HIV 护理的重新参与。
