Faculty of Health Sciences, South African Research Chairs Initiative (SARChI), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Faculty of Health Sciences, School of Nursing Science, North-West University, Potchefstroom, South Africa.
PLoS One. 2023 Apr 26;18(4):e0284996. doi: 10.1371/journal.pone.0284996. eCollection 2023.
Ensuring that all HIV-infected people receive antiretroviral therapy (ART) and achieve viral suppression are key South African strategies to end the AIDS epidemic in the country. National HIV treatment guidelines recommend an immediate switch to second-line ART following virological failure with first-line ART. Nurses based in district health facilities are at the forefront of implementing this recommendation. While there are often delays in switching and in some instances no switch, the reasons for and barriers to delayed switching are not well understood at the primary care level.
To explore the views of frontline nursing staff about factors contributing to delayed switching of patients who have failed first-line ART regimen in Ekurhuleni district, South Africa.
A qualitative study was conducted among 21 purposively sampled nurses who provide HIV treatment and care to patients in 12 primary health care (PHC) facilities in Ekurhuleni Health District, Gauteng Province, South Africa. Individual in-depth interviews explored nurses' experiences regarding their recognition of virological failure and understanding of "on time" switching to second-line ART. Interviews probed the circumstances contributing to delays in switching. After digital audio recording and transcription, manual inductive thematic analysis was used to analyse the data.
Multiple barriers were identified: 1) Healthcare provider factors included a lack of knowledge and confidence coupled with demotivation in the workplace; 2) Patient issues similarly comprised a lack of knowledge as well as resistance to being switched to another drug regimen and loss to follow up; 3) Systems factors were poor facility leadership, shortages of medication, staffing constraints, and the inability to trace laboratory results, especially for migrant patients.
Reasons for delayed switching of patients to second-line ART are multifactorial and require integrated interventions at health provider, patient and health system levels.
确保所有感染艾滋病毒的人都接受抗逆转录病毒疗法（ART）并实现病毒抑制，是南非终结该国艾滋病疫情的关键策略。国家艾滋病毒治疗指南建议，在一线 ART 治疗失败后，立即转换为二线 ART。驻地区域卫生设施的护士是执行这一建议的第一线人员。尽管经常会出现延迟转换的情况，有时甚至不进行转换，但在初级保健层面，对于延迟转换的原因和障碍还了解甚少。
探索一线护理人员对南非埃库鲁莱尼地区一线抗逆转录病毒治疗方案失败的患者延迟转换的看法，分析导致这种情况的因素。
在南非豪登省埃库鲁莱尼卫生区的 12 个初级保健（PHC）设施中，对 21 名有 HIV 治疗和护理经验的护士进行了一项定性研究。采用个人深入访谈的方式，了解护士在识别病毒学失败和理解按时转换到二线 ART 方面的经验。访谈内容还包括探讨导致转换延迟的情况。对数字音频录音和转录进行分析，采用手动归纳主题分析方法对数据进行分析。
确定了多个障碍：1）医疗保健提供者因素包括知识和信心不足，工作场所动力不足；2）患者问题同样包括缺乏知识，以及对转换到另一种药物方案的抵触和失去随访；3）系统因素包括设施领导不力、药物短缺、人员配备限制，以及无法追踪实验室结果，尤其是对于移民患者。
患者延迟转换为二线 ART 的原因是多方面的，需要在卫生提供者、患者和卫生系统层面采取综合干预措施。
