南非医疗卫生服务提供者对普遍检测和治疗政策实施的看法：一项定性研究。

Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: a qualitative inquiry.

机构信息

Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg, 7505, South Africa.

Division of Health Systems and Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.

出版信息

BMC Health Serv Res. 2023 Mar 28;23(1):293. doi: 10.1186/s12913-023-09281-2.

DOI:10.1186/s12913-023-09281-2

PMID:36978086

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10045036/

Abstract

BACKGROUND

South Africa had an estimated 7.5 million people living with HIV (PLHIV), accounting for approximately 20% of the 38.4 million PLHIV globally in 2021. In 2015, the World Health Organization recommended the universal test and treat (UTT) intervention which was implemented in South Africa in September 2016. Evidence shows that UTT implementation faces challenges in terms of human resources capacity or infrastructure. We aim to explore healthcare providers (HCPs)' perspectives on the implementation of the UTT strategy in uThukela District Municipality in KwaZulu-Natal province.

METHODS

A qualitative study was conducted with one hundred and sixty-one (161) healthcare providers (HCPs) within 18 healthcare facilities in three subdistricts, comprising of Managers, Nurses, and Lay workers. HCPs were interviewed using an open ended-survey questions to explore their perceptions providing HIV care under the UTT strategy. All interviews were thematically analysed using both inductive and deductive approaches.

RESULTS

Of the 161 participants (142 female and 19 male), 158 (98%) worked at the facility level, of which 82 (51%) were nurses, and 20 (12.5%) were managers (facility managers and PHC manager/supervisors). Despite a general acceptance of the UTT policy implementation, HCPs expressed challenges such as increased patient defaulter rates, increased work overload, caused by the increased number of service users, and physiological and psychological impacts. The surge in the workload under conditions of inadequate systems' capacity and human resources, gave rise to a greater burden on HCPs in this study. However, increased life expectancy, good quality of life, and immediate treatment initiation were identified as perceived positive outcomes of UTT on service users. Perceived influence of UTT on the health system included, increased number of patients initiated, decreased burden on the system, meeting the 90-90-90 targets, and financial aspects.

CONCLUSION

Health system strengthening such as providing more systems' capacity for expected increase in workload, proper training and retraining of HCPs with new policies in the management of patient readiness for lifelong ART journey, and ensuring availability of medicines, may reduce strain on HCPs, thus improving the delivery of the comprehensive UTT services to PLHIV.

摘要

背景

南非估计有 750 万人感染艾滋病毒（PLHIV），约占 2021 年全球 3840 万 PLHIV 的 20%。2015 年，世界卫生组织建议实施普遍检测和治疗（UTT）干预措施，该措施于 2016 年 9 月在南非实施。有证据表明，UTT 的实施在人力资源能力或基础设施方面面临挑战。我们旨在探讨夸祖鲁-纳塔尔省乌特库拉地区医疗保健提供者（HCP）对实施 UTT 战略的看法。

方法

对 18 个医疗设施中的 161 名（161）医疗保健提供者（HCP）进行了定性研究，其中包括管理人员、护士和护理人员。使用开放式调查问题对 HCP 进行访谈，以探讨他们在 UTT 战略下提供艾滋病毒护理的看法。所有访谈均采用归纳和演绎方法进行主题分析。

结果

在 161 名参与者中（142 名女性和 19 名男性），158 名（98%）在设施一级工作，其中 82 名（51%）是护士，20 名（12.5%）是管理人员（设施经理和 PHC 经理/主管）。尽管普遍接受了 UTT 政策的实施，但 HCP 表示存在挑战，例如由于服务使用者人数增加，患者拖欠率增加，工作负荷增加，以及生理和心理影响。在系统能力和人力资源不足的情况下，工作量的增加给本研究中的 HCP 带来了更大的负担。然而，增加预期寿命、提高生活质量和立即开始治疗被认为是 UTT 对服务使用者的积极结果。UTT 对卫生系统的感知影响包括增加开始治疗的患者数量、减轻系统负担、实现 90-90-90 目标以及财务方面。