Research Department, Elizabeth Glaser Pediatric AIDS Foundation, Washington, D.C, USA.
Ministry of Health and Social Services, Windhoek, Namibia.
BMC Health Serv Res. 2022 Apr 14;22(1):498. doi: 10.1186/s12913-022-07928-0.
Namibia is a large sparsely populated country with a high prevalence of HIV. People living with HIV who reside in remote areas often travel long distances through tough desert terrain to access HIV care and treatment. To address this barrier, community-based antiretroviral therapy (C-BART) sites were established in Okongo (2007-2008) and Eenhana districts (2016) of northern Namibia with the goal of bringing HIV and other health services closer patients' homes. We conducted a qualitative evaluation of the acceptability and challenges of C-BART to guide program improvement.
For this qualitative descriptive study, research assistants collected data (August-December 2017) through in-depth interviews with 40 patients, seven health extension workers, and 11 policy/program managers, and through four focus group discussions with healthcare workers. Interviews were audio-recorded, translated, and coded using MAXQDA v.12. Data were analyzed using thematic analysis.
The evaluation identified five themes: community ownership, acceptance of the C-BART sites, benefits of the C-BART program for the PLHIV community and their social networks, benefits of the C-BART program to the main health facility, and challenges with the C-BART program. The C-BART program was reported as life-changing by many patients who had previously struggled to afford four-wheel drive vehicles to access care. Patients and healthcare workers perceived that the community as a whole benefited from the C-BART sites not only due to the financial pressure lifted from friends and family members previously asked to help cover expensive transportation, but also due to the perception of diminished stigmatization of people living with HIV and improved health. The C-BART sites became a source of community and social support for those accessing the sites. Healthcare workers reported greater job satisfaction and decongestion of health facilities. The challenges that they reported included delays in authorization of vehicles for transportation to C-BART sites and lack of incentives to provide services in the community.
The C-BART program can serve as a model of care to expand access to HIV care and treatment and other health services to populations in remote settings, including rural and difficult-to-reach regions. The needs of healthcare workers should also be considered for the optimal delivery of such a model.
纳米比亚是一个人口稀少的大国，艾滋病毒感染率很高。居住在偏远地区的艾滋病毒感染者往往要长途跋涉穿越艰苦的沙漠地形，才能获得艾滋病毒护理和治疗。为了解决这一障碍，纳米比亚北部的奥孔戈（2007-2008 年）和埃纳哈纳区（2016 年）设立了以社区为基础的抗逆转录病毒治疗（C-BART）点，目的是使艾滋病毒和其他卫生服务更接近患者的家。我们对 C-BART 的可接受性和挑战进行了定性评估，以指导项目改进。
在这项定性描述性研究中，研究助理通过对 40 名患者、7 名卫生推广人员和 11 名政策/方案管理人员进行深入访谈，并通过与卫生保健工作者进行 4 次焦点小组讨论，收集了数据（2017 年 8 月至 12 月）。访谈内容通过 MAXQDA v.12 进行录音、翻译和编码。使用主题分析对数据进行分析。
评估确定了五个主题：社区所有权、对 C-BART 站点的接受程度、C-BART 方案对 PLHIV 社区及其社交网络的好处、C-BART 方案对主要卫生机构的好处以及 C-BART 方案面临的挑战。许多患者认为 C-BART 项目改变了他们的生活，他们以前为了获得四轮驱动车辆以获得护理而挣扎。患者和卫生保健工作者认为，整个社区都受益于 C-BART 站点，不仅因为朋友和家人以前因帮助支付昂贵的交通费用而减轻了经济压力，还因为人们对艾滋病毒感染者的污名化程度降低和健康状况改善的看法。C-BART 站点成为那些访问该站点的人的社区和社会支持的来源。卫生保健工作者报告说，工作满意度提高，卫生设施拥堵减轻。他们报告的挑战包括运输到 C-BART 站点的车辆授权延迟以及缺乏在社区提供服务的激励措施。
C-BART 方案可以作为扩大艾滋病毒护理和治疗以及其他卫生服务在偏远地区人群中获得的护理模式，包括农村和难以到达的地区。还应考虑卫生保健工作者的需求，以最佳地提供这种模式。
