Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
Infectious Diseases Research Collaboration, Kampala, Uganda.
Soc Sci Med. 2023 Feb;318:115471. doi: 10.1016/j.socscimed.2022.115471. Epub 2022 Oct 28.
Population mobility is prevalent and complex in sub-Saharan Africa, and can disrupt HIV care and fuel onward transmission. While differentiated care models show promise for meeting the needs of mobile populations by addressing care cascade gaps, the voices of mobile populations need to be included when designing care delivery models. We assessed the unmet needs of mobile populations and engaged mobile stakeholders in the design and implementation of service delivery to improve care outcomes for mobile people living with HIV (PLHIV).
CBPR was conducted in 12 rural communities in Kenya and Uganda participating in a mobility study within the Sustainable East Africa Research in Community Health (SEARCH) test-and-treat trial (NCT# 01864603) from 2016 to 2019. Annual gender-balanced meetings with between 17 and 33 mobile community stakeholders per meeting were conducted in local languages to gather information on mobility and its influence on HIV-related outcomes. Discussions were audio-recorded, transcribed and translated into English. Findings were shared at subsequent meetings to engage mobile stakeholders in interpretation. At year three, intervention ideas to address mobile populations' needs were elicited. After refinement, these intervention options were presented to the same communities for prioritization the following year, using a participatory ranking approach.
Transit hubs, trading centers, and beach sites were identified as desirable service locations. Communities prioritized mobile health 'cards' with electronic medical records and peer-delivered home-based services. Mobile health clinics, longer antiretroviral refills, and 24/7 (after service) were less desirable options. Care challenges included: lack of transfer letters to other clinics; inability to adhere to scheduled appointments, medication regimens, and monitoring of treatment outcomes while mobile amongst others.
Iterative discussions with mobile community stakeholders elicited communities' health priorities and identified challenges to achieving HIV care cascade outcomes. Understanding the mobility patterns and unique needs of mobile populations through responsive community engagement is critical.
撒哈拉以南非洲的人口流动普遍且复杂，这可能会扰乱 HIV 护理并助长病毒的进一步传播。虽然差异化护理模式有望通过解决护理级联差距来满足流动人口的需求，但在设计护理服务模式时，需要纳入流动人口的意见。我们评估了流动人口的未满足需求，并让流动利益相关者参与服务提供的设计和实施，以改善流动 HIV 感染者（PLHIV）的护理结果。
2016 年至 2019 年，在东非可持续社区健康研究（SEARCH）测试和治疗试验（NCT#01864603）中，在肯尼亚和乌干达的 12 个农村社区开展了基于社区的研究（CBPR）。每年以当地语言举行 17 至 33 名流动社区利益相关者参加的性别均衡会议，以收集有关流动及其对与 HIV 相关结果的影响的信息。讨论内容被录音、转录并翻译成英文。研究结果在随后的会议上分享，以让流动利益相关者参与解释。在第三年，提出了满足流动人口需求的干预想法。经过完善，次年使用参与式排名方法，向同一社区提出这些干预选择，供其优先考虑。
过境枢纽、贸易中心和海滩地点被确定为理想的服务地点。社区优先考虑带有电子病历和由同伴提供的上门服务的移动医疗卡。移动医疗诊所、更长的抗逆转录病毒药物续药和 24/7 服务（服务后）是不太理想的选择。护理方面的挑战包括：缺乏转介到其他诊所的转介信；在流动期间，无法遵守预约、药物治疗方案和治疗结果监测等。
通过与流动社区利益相关者的反复讨论，确定了社区的健康重点和实现 HIV 护理级联结果的挑战。通过响应社区参与，了解流动人口的流动模式和独特需求至关重要。
