患者对艾滋病抗病毒治疗服务提供的体验和偏好:对埃塞俄比亚西北部差异化服务提供的启示。

Patient experiences and preferences for antiretroviral therapy service provision: implications for differentiated service delivery in Northwest Ethiopia.

机构信息

Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.

Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

出版信息

AIDS Res Ther. 2022 Jun 27;19(1):30. doi: 10.1186/s12981-022-00452-5.

Abstract

BACKGROUND

Understanding the experiences, needs, preferences, and behaviors of people living with HIV (PLHIV) are critical to tailor HIV treatment. However, there is limited empirical evidence in Ethiopia on the views of PLHIV regarding their experiences with current antiretroviral therapy (ART) services and preferred models of HIV treatment. Hence, this study aimed to explore the patients' experiences of taking medications and preferences for ART service provision in Northwest Ethiopia.

METHODS

A phenomenological study design was employed. In this study, stable and 18 years old and above PLHIVs, who had been using ART service at four public hospitals and two health centers in East Gojjam, West Gojjam and Awi zones, and Bahir Dar city administration of Amhara National Regional State, Northwest Ethiopia, were purposively selected. Fifteen in-depth interviews were conducted from July 2021 to September 2021 to collect data. ATLAS.ti version 9 software was used for coding translated transcripts. A thematic analysis approach was employed.

FINDINGS

Participants in this study had reported positive and negative experiences in receiving ART services and also varied preferences toward ART service features. The study identified five themes on experiences for ART service and 15 attributes of ART service characteristics. The identified themes were stigma, time, availability of drugs and providers, costs for clinic visits, and provider-patient interaction. The fifteen attributes were buddy system, ART refill (individualized or group), ART packaging and labeling, drug formulation and administration, ART room labeling, distance, location of service, preferences on involvement in treatment decision-making, the person providing ART refills, provider's attitude, spatial arrangement of ART room, time of health facility operation, time spent at clinics, and total cost of the visit.

CONCLUSIONS

The results raise awareness for the positive and negative experiences of patients informing us about barriers and supporting factors in ART service provision. They open up the potential for HIV treatment service improvement. The preferences of PLHIVs toward ART service delivery features were heterogeneous. Policy and program efforts should tailor ART services that suit patients' needs and priorities in Ethiopia. Future research should further assess the reasons for patients' distrust of the community ART delivery models.

摘要

背景

了解感染艾滋病毒者(PLHIV)的经历、需求、偏好和行为对于量身定制艾滋病毒治疗至关重要。然而,在埃塞俄比亚,关于 PLHIV 对当前抗逆转录病毒疗法(ART)服务的体验以及对艾滋病毒治疗首选模式的看法,实证证据有限。因此,本研究旨在探讨西北地区 PLHIV 服用药物的体验以及对 ART 服务提供的偏好。

方法

采用现象学研究设计。在这项研究中,我们在东戈贾姆、西戈贾姆和阿维地区以及阿姆哈拉州巴希尔达尔市行政当局的四家公立医院和两家卫生中心,选择了稳定且年满 18 岁的正在使用 ART 服务的 PLHIV 进行了 15 次深入访谈,以收集数据。2021 年 7 月至 9 月期间进行了访谈。使用 ATLAS.ti 版本 9 软件对翻译后的记录进行编码。采用主题分析方法。

结果

本研究中的参与者报告了在接受 ART 服务方面的积极和消极体验,并且对 ART 服务特征也有不同的偏好。研究确定了关于 ART 服务体验的五个主题和 ART 服务特征的 15 个属性。确定的主题包括耻辱感、时间、药物和提供者的可用性、就诊费用以及医患互动。15 个属性包括伙伴系统、ART 补充(个体化或集体)、ART 包装和标签、药物配方和管理、ART 室标签、距离、服务地点、参与治疗决策的偏好、提供 ART 补充的人、提供者的态度、ART 室的空间布置、医疗机构运营时间、在诊所花费的时间以及就诊的总费用。

结论

研究结果引起了对患者积极和消极体验的关注,让我们了解了在提供 ART 服务方面的障碍和支持因素。它们为改善艾滋病毒治疗服务提供了潜力。PLHIV 对 ART 服务提供特征的偏好是多种多样的。埃塞俄比亚的政策和规划工作应根据患者的需求和优先事项调整 ART 服务。未来的研究应进一步评估患者对社区 ART 提供模式不信任的原因。

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