Institute of Tropical Medicine, Antwerp, Belgium.
APIN Public Health Initiatives, Abuja, Nigeria.
BMC Public Health. 2023 May 12;23(1):870. doi: 10.1186/s12889-023-15774-w.
The community-based antiretroviral therapy delivery (CBART) model was implemented in Benue State in Nigeria to increase access of key populations living with HIV (KPLHIV) to antiretroviral treatment. Key populations (KP) are female sex workers, men who have sex with men, persons who inject drugs, and transgender people. Evidence shows that the CBART model for KP (KP-CBART) can improve HIV outcomes along the cascade of HIV care and treatment in sub-Saharan Africa. However, how KP-CBART works, for whom, why, and under what circumstances it generates specific outcomes are not yet clear. Therefore, the aim of this study is to identify the initial programme theory (IPT) of the KP-CBART in Benue State using a realist approach.
The study design is exploratory and qualitative, exploring the implementation of KP-CBART. We reviewed the intervention logic framework & guidelines for the KP-CBART in Nigeria, conducted a desk review of KP-CBART in Sub-Saharan Africa (SSA) and interviewed programme managers in the Benue HIV programme between November 2021 and April 2022. Findings were synthesized using the Context-Mechanism-Outcome (CMO) heuristic tool to explain the relationship between the different types of CBART models, contextual factors, actors, mechanisms and outcomes. Using a generative causality logic (retroduction and abduction), we developed, following a realist approach, CMO configurations (CMOc), summarized as an empirically testable IPT.
We developed 7 CMOc and an IPT of the KP-CBART. Where KPLHIV receive ART in a safe place while living in a setting of punitive laws, harassment, stigma and discrimination, KP will adhere to treatment and be retained in care because they feel safe and trust the healthcare providers. Where KPLHIV are involved in the design, planning and implementation of HIV services; medication adherence and retention in care will improve because KP clients perceive HIV services to be KP-friendly and participate in KP-CBART.
Implementation of CBART model where KPLHIV feel safe, trust healthcare providers, and participate in HIV service delivery can improve medication adherence and retention in care. This programme hypothesis will be tested and refined in the next phase of the realist evaluation of KP-CBART.
社区为基础的抗逆转录病毒治疗提供模式（CBART）在尼日利亚贝努埃州实施，以增加艾滋病毒感染者（PLHIV）获得抗逆转录病毒治疗的机会。重点人群（KP）包括性工作者、男男性行为者、注射毒品者和跨性别者。有证据表明，KP 的 CBART 模式（KP-CBART）可以改善撒哈拉以南非洲国家 HIV 护理和治疗的 HIV 护理和治疗的一系列结果。然而，KP-CBART 如何运作、为谁服务、为什么以及在什么情况下产生特定的结果尚不清楚。因此，本研究旨在使用现实主义方法确定贝努埃州 KP-CBART 的初始方案理论（IPT）。
本研究设计是探索性和定性的，探索 KP-CBART 的实施情况。我们审查了尼日利亚 KP-CBART 的干预逻辑框架和指南，对撒哈拉以南非洲（SSA）的 KP-CBART 进行了桌面审查，并于 2021 年 11 月至 2022 年 4 月期间采访了贝努埃州 HIV 项目的项目管理人员。使用上下文-机制-结果（CMO）启发式工具综合发现，以解释不同类型的 CBART 模式、上下文因素、行为者、机制和结果之间的关系。使用生成因果逻辑（回溯和归纳），我们按照现实主义方法开发了 CMO 配置（CMOc），总结为一个可经验检验的 IPT。
我们开发了 7 个 CMOc 和一个 KP-CBART 的 IPT。在这种情况下，PLHIV 在受到惩罚性法律、骚扰、污名和歧视的环境中，在安全的地方接受 ART 治疗，他们会坚持治疗并保持护理，因为他们感到安全并信任医疗保健提供者。在 KP 参与 HIV 服务的设计、规划和实施的情况下；药物依从性和护理保留率将提高，因为 KP 客户认为 HIV 服务对 KP 友好，并参与 KP-CBART。
实施 CBART 模式，让 PLHIV 感到安全、信任医疗保健提供者，并参与 HIV 服务提供，可以提高药物依从性和护理保留率。这一方案假设将在下一阶段的 KP-CBART 现实主义评价中进行测试和完善。
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