Johns Hopkins University, 1550 Orleans St, CRB II - 1M11, Baltimore, MD, 21205, USA.
Aurum Institute, Johannesburg, South Africa.
BMC Health Serv Res. 2022 Aug 26;22(1):1092. doi: 10.1186/s12913-022-08469-2.
Correctional settings in South Africa have disproportionately high rates of HIV infection; a large number of inmates living with HIV return to the community each year. The transition community adherence club (TCAC) intervention was a differentiated care delivery approach with structural and peer components designed to increase antiretroviral therapy (ART) adherence and HIV care engagement following release from incarceration. The objective of this study was to assess the acceptability of the TCAC intervention among HIV-infected community re-entrants to inform program revisions and future intervention designs.
This was a qualitative study set within a randomized controlled trial (RCT) of the TCAC intervention in South Africa. We conducted semi-structured, in-depth interviews with 16 re-entrants living with HIV and assigned to the intervention arm. All interviews were audio-recorded, transcribed, translated, and de-identified. Transcripts were coded and analyzed using content analysis, and acceptability was assessed using the Theoretical Framework of Acceptability (TFA).
Overall, study participants reported that the TCAC intervention was acceptable. Development of supportive relationships between participants, non-judgmental attitudes from peer-facilitators, and perceived effectiveness of the intervention to support ART adherence and HIV care were noted as the most valued components. An altruistic desire to help other participants facing similar post-incarceration and HIV-related challenges was a key motivator for TCAC attendance. A lack of access to reliable transportation to intervention sites and clinic-based medication collection were described as burdens to program participation. Illicit drug use by other group members and negative social influences were also identified as potential barriers to optimal program engagement.
The TCAC was a well-accepted model of differentiated care delivery among re-entrants living with HIV in South Africa. To further enhance intervention acceptability for future scale-ups, program revisions should address logistical barriers related to reaching TCAC sites and implementing ART distribution at TCAC group sessions.
南非的惩教机构中艾滋病毒感染率过高；每年都有大量感染艾滋病毒的囚犯返回社区。过渡社区依从俱乐部（TCAC）干预措施是一种差异化的护理提供方法，具有结构性和同伴性组成部分，旨在增加从监禁中释放后的抗逆转录病毒治疗（ART）依从性和艾滋病毒护理参与度。本研究的目的是评估 TCAC 干预措施在感染艾滋病毒的社区重新进入者中的可接受性，为项目修订和未来的干预设计提供信息。
这是一项在南非的 TCAC 干预措施的随机对照试验（RCT）中进行的定性研究。我们对 16 名感染艾滋病毒并被分配到干预组的重新进入者进行了半结构式深入访谈。所有访谈均进行录音、转录、翻译和匿名处理。使用内容分析法对抄本进行编码和分析，并使用可接受性理论框架（TFA）评估可接受性。
总体而言，研究参与者报告说 TCAC 干预措施是可以接受的。参与者之间建立支持性关系、同伴促进者的非评判态度以及干预措施对支持 ART 依从性和艾滋病毒护理的有效性被认为是最有价值的组成部分。帮助其他面临类似监禁后和艾滋病毒相关挑战的参与者的利他愿望是参加 TCAC 的关键动机。无法获得可靠的交通工具前往干预地点和诊所收集药物被描述为参与项目的负担。其他小组成员的非法药物使用和负面的社会影响也被确定为优化项目参与的潜在障碍。
TCAC 是南非感染艾滋病毒的重新进入者差异化护理提供的一种可行模式。为了进一步提高未来扩大规模的干预措施的可接受性，项目修订应解决与到达 TCAC 地点和在 TCAC 小组会议上实施 ART 分配相关的后勤障碍。
