在乌干达农村，社区卫生工作者主导的机制在支持异性恋 HIV 感染者披露 HIV 方面的经验和挑战。

Experiences and challenges of using community health worker-led mechanism in supporting HIV disclosure among adults living with HIV in heterosexual relationships in the rural Uganda.

机构信息

Johns Hopkins University Collaboration (MU-JHU), Makerere University, Upper Mulago Hill Road, Kampala, Uganda.

School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.

出版信息

AIDS Res Ther. 2023 Mar 11;20(1):14. doi: 10.1186/s12981-023-00508-0.

DOI:10.1186/s12981-023-00508-0

PMID:36906557

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10008611/

Abstract

BACKGROUND

HIV status disclosure among sexual partners is vital in HIV management. Community health workers (CHW) support HIV disclosure among adults living with HIV (ALHIV) in sexual relationships with disclosure difficulties. However, experiences and challenges of using CHW-led disclosure support mechanism were not documented. This study explored experiences and challenges involved in using CHW-led disclosure support mechanism among ALHIV in heterosexual relationships in the rural Uganda.

METHODS

This was a phenomenological qualitative study involving in-depth interviews among CHWs and ALHIV with HIV disclosure difficulties to sexual partners in greater Luwero region, Uganda. We conducted 27 interviews among purposively selected CHWs and participants who had participated in the CHW-led disclosure support mechanism. Interviews were conducted until saturation was reached; and analysis was done using inductive and deductive content analysis in Atlas.

RESULTS

All respondents viewed HIV disclosure as an important strategy in HIV management. Provision of adequate counseling and support to those intending to disclose was instrumental for successful disclosure. However, fear of the negative disclosure outcomes was viewed as a barrier to disclosure. The CHWs were viewed as having an added advantage in supporting disclosure as opposed to the routine disclosure counseling. However, HIV disclosure using CHW-led support mechanism would be limited by possible bleach of client's confidentiality. Therefore, respondents thought that appropriate selection of CHWs would improve their trust in the community. Additionally, providing CHWs with adequate training and facilitation during the disclosure support mechanism was viewed to improve their work.

CONCLUSION

Community health workers were viewed as being more supportive in HIV disclosure among ALHIV with disclosure difficulties to sexual partners compared to routine facility based disclosure counseling. Therefore, near location CHW-led disclosure mechanism was acceptable and useful in supporting HIV disclosure among HIV-affected sexual partners in rural settings.

摘要

背景

在 HIV 管理中，性伴侣之间的 HIV 状况披露至关重要。社区卫生工作者（CHW）支持与 HIV 感染者（ALHIV）有困难的性伴侣进行 HIV 披露，但并未记录使用 CHW 主导的披露支持机制的经验和挑战。本研究探讨了在乌干达农村地区，与异性恋关系中的 ALHIV 相关的使用 CHW 主导的披露支持机制的经验和挑战。

方法

这是一项现象学定性研究，涉及在乌干达卢韦罗地区，对有困难向性伴侣披露 HIV 的 CHW 和 ALHIV 进行深入访谈。我们对 27 名 CHW 和参与者进行了访谈，这些参与者是通过 CHW 主导的披露支持机制选择的。访谈一直进行到达到饱和为止；并在 Atlas 中使用归纳和演绎内容分析进行分析。

结果

所有受访者都认为 HIV 披露是 HIV 管理的重要策略。为那些打算披露的人提供充分的咨询和支持对于成功披露至关重要。然而，对负面披露结果的恐惧被视为披露的障碍。CHW 被认为在支持披露方面具有优势，而不是常规的披露咨询。然而，使用 CHW 主导的支持机制进行 HIV 披露可能会因客户保密性的泄露而受到限制。因此，受访者认为适当选择 CHW 将提高他们对社区的信任。此外，在披露支持机制期间，为 CHW 提供充分的培训和促进被认为可以提高他们的工作效率。