乌干达坎帕拉在2019年冠状病毒病疫情限制期间对艾滋病毒服务提供的调整:一项定性研究
Adaptations to HIV services delivery amidst the COVID-19 pandemic restrictions in Kampala, Uganda: A qualitative study.
作者信息
Izudi Jonathan, Kiragga Agnes N, Okoboi Stephen, Bajunirwe Francis, Castelnuovo Barbara
机构信息
Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda.
African Population and Health Research Center, Nairobi, Kenya.
出版信息
PLOS Glob Public Health. 2022 Aug 23;2(8):e0000908. doi: 10.1371/journal.pgph.0000908. eCollection 2022.
The enforcement of the coronavirus disease (COVID-19) pandemic restrictions disrupted health services delivery and currently, there is a limited understanding regarding measures employed by health facilities to ensure delivery of human immunodeficiency virus (HIV) services amidst the interruptions. We, therefore, designed a qualitative study to explore the measures for continuity of HIV services during the COVID-19 pandemic restrictions in Kampala, Uganda. This study was conducted at six large primary health care facilities in the Kampala Metropolitan area. Qualitative data were collected from anti-retroviral therapy (ART) focal persons and lay health workers namely linkage facilitators and peer mothers through key informant interviews (KIIs). Overall, 14 KIIs were performed, 10 with lay health workers and 4 with ART focal persons. Data were audio-recorded, transcribed verbatim, and analyzed using the content approach, and the results were presented as themes along with participant quotations. Five themes emerged to describe measures for continuity of HIV services. The measures included: 1) leveraging the use of mobile phone technology to support ART adherence counseling, psychosocial care, and reminders concerning clinic appointments and referrals; 2) adoption of novel differentiated service delivery models for ART like the use of motorcycle taxis and introduction of an individualized ART delivery model for patients with non-disclosed HIV status; 3) scale-up of existing differentiated service delivery models for ART, namely multi-month dispensing of antiretroviral drugs (ARVs), fast-track ARV refill, home-based ARV refill, peer ART delivery, use of community pharmacy model, and community client-led ART delivery model; and, 4) reorientation of health facility functioning to the COVID-19 pandemic restrictions characterized by the use of nearby health facilities for ARV refill and viral load monitoring, transportation of healthcare providers and flexible work schedules and reliance on shift work. We found several measures were adopted to deliver HIV care, treatment, and support services during the COVID-19 pandemic restrictions in Kampala, Uganda. We recommend the scale-up of the new measures for service continuity in the post-COVID-19 period.
新冠疫情防控措施的实施扰乱了医疗服务的提供,目前,对于医疗机构在中断期间采取何种措施来确保提供人类免疫缺陷病毒(HIV)服务,人们的了解有限。因此,我们开展了一项定性研究,以探索在乌干达坎帕拉实施新冠疫情防控措施期间HIV服务的持续提供措施。本研究在坎帕拉都会区的六个大型初级卫生保健机构进行。通过关键信息人访谈(KIIs),从抗逆转录病毒疗法(ART)协调员以及非专业卫生工作者(即转诊协调员和同伴母亲)处收集定性数据。总共进行了14次关键信息人访谈,其中10次访谈对象为非专业卫生工作者,4次访谈对象为ART协调员。对数据进行了录音、逐字转录,并采用内容分析法进行分析,结果以主题及参与者引述的形式呈现。出现了五个主题来描述HIV服务持续提供的措施。这些措施包括:1)利用移动电话技术支持ART依从性咨询、心理社会护理以及关于门诊预约和转诊的提醒;2)采用新的ART差异化服务提供模式,如使用摩的,并为未公开HIV感染状况的患者引入个性化ART给药模式;3)扩大现有的ART差异化服务提供模式,即抗逆转录病毒药物(ARV)的多月量配药、快速ARV续方、居家ARV续方、同伴ART给药、社区药房模式以及社区患者主导ART给药模式;4)将医疗机构的运作调整为适应新冠疫情防控措施,特点是利用附近医疗机构进行ARV续方和病毒载量监测、医护人员的交通安排以及灵活的工作时间表,并依赖轮班工作。我们发现,在乌干达坎帕拉实施新冠疫情防控措施期间,采取了多项措施来提供HIV护理、治疗和支持服务。我们建议在新冠疫情后扩大这些新的服务持续提供措施。