Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, South Carolina, USA.
J Int AIDS Soc. 2021 Oct;24(10):e25805. doi: 10.1002/jia2.25805.
No studies from sub-Saharan Africa have attempted to assess HIV service delivery preferences among incarcerated people living with HIV as they transition from prisons to the community ("releasees"). We conducted a discrete choice experiment (DCE) to characterize releasee preferences for transitional HIV care services in Zambia to inform the development of a differentiated service delivery model to promote HIV care continuity for releasees.
Between January and October 2019, we enrolled a consecutive sample of 101 releasees from a larger cohort prospectively following 296 releasees from five prisons in Zambia. We administered a DCE eliciting preferences for 12 systematically designed choice scenarios, each presenting three hypothetical transitional care options. Options combined six attributes: (1) clinic type for post-release HIV care; (2) client focus of healthcare workers; (3) transitional care model type; (4) characteristics of transitional care provider; (5) type of transitional care support; and (6) HIV status disclosure support. We analysed DCE choice data using a mixed logit model, with coefficients describing participants' average ("mean") preferences for each option compared to the standard of care and their distributions describing preference variation across participants.
Most DCE participants were male (n = 84, 83.2%) and had completed primary school (n = 54, 53.5%), with 29 (28.7%) unemployed at follow-up. Participants had spent an average of 8.2 months in the community prior to the DCE, with 18 (17.8%) reporting an intervening episode of re-incarceration. While we observed significant preference variation across participants (p < 0.001 for most characteristics), releasees were generally averse to clinics run by community-based organizations versus government antiretroviral therapy clinics providing post-release HIV care (mean preference = -0.78, p < 0.001). On average, releasees most preferred livelihood support (mean preference = 1.19, p < 0.001) and HIV care support (mean preference = 1.00, p < 0.001) delivered by support groups involving people living with HIV (mean preference = 1.24, p < 0.001).
We identified preferred characteristics of transitional HIV care that can form the basis for differentiated service delivery models for prison releasees. Such models should offer client-centred care in trusted clinics, provide individualized HIV care support delivered by support groups and/or peer navigators, and strengthen linkages to programs providing livelihood support.
没有来自撒哈拉以南非洲的研究试图评估感染艾滋病毒的被监禁者在从监狱过渡到社区（“释放者”）时对艾滋病毒服务提供的偏好。我们进行了一项离散选择实验（DCE），以描述赞比亚释放者对过渡性艾滋病毒护理服务的偏好，为制定差异化服务提供模式以促进释放者的艾滋病毒护理连续性提供信息。
2019 年 1 月至 10 月，我们从赞比亚五个监狱的 296 名释放者中前瞻性地连续招募了一批连续样本，共招募了 101 名释放者。我们进行了一项 DCE，以确定 12 种系统设计的选择方案中的偏好，每个方案都提出了三种假设的过渡性护理方案。方案结合了六个属性：（1）艾滋病毒护理后释放者的诊所类型；（2）医疗保健工作者的服务对象；（3）过渡性护理模式类型；（4）过渡性护理提供者的特征；（5）过渡性护理支持类型；（6）艾滋病毒状况披露支持。我们使用混合对数模型分析 DCE 选择数据，系数描述了参与者与护理标准相比对每个选项的平均（“平均”）偏好，以及参与者之间偏好差异的分布。
大多数 DCE 参与者为男性（n=84，83.2%），完成了小学教育（n=54，53.5%），在随访时，29 人（28.7%）失业。参与者在社区中的平均停留时间为 8.2 个月，18 人（17.8%）报告有中途再监禁的情况。虽然我们观察到参与者之间存在显著的偏好差异（大多数特征的 p<0.001），但释放者普遍不喜欢由社区组织经营的诊所，而不是由政府提供抗逆转录病毒治疗诊所提供的艾滋病毒护理后服务（平均偏好=-0.78，p<0.001）。平均而言，释放者最希望获得生计支持（平均偏好=1.19，p<0.001）和艾滋病毒护理支持（平均偏好=1.00，p<0.001），这些支持由涉及艾滋病毒感染者的支持小组提供（平均偏好=1.24，p<0.001）。
我们确定了过渡性艾滋病毒护理的首选特征，这些特征可以为监狱释放者制定差异化服务提供模式提供基础。这些模式应提供以患者为中心的信任诊所护理，提供由支持小组和/或同伴导航员提供的个性化艾滋病毒护理支持，并加强与提供生计支持的方案的联系。
