Kiyingi Micheal, Nankabirwa Joaniter I, Wiltshire Christine Sekaggya, Nangendo Joan, Kiweewa John M, Katahoire Anne R, Semitala Fred C
Department of Medicine, Makerere University, Kampala, Uganda.
Makerere University Joint AIDS Program, Makerere University, Kampala, Uganda.
PLOS Glob Public Health. 2023 Jul 26;3(7):e0001483. doi: 10.1371/journal.pgph.0001483. eCollection 2023.
Early initiation of antiretroviral therapy (ART) after HIV diagnosis prevents HIV transmission, progression of HIV to AIDS and improves quality of life. However, little is known about the barriers to timely ART initiation among patients who test HIV positive in settings different from where they will receive HIV treatment, hence are referred in the routine setting. Therefore, we explored the perspectives of people living with HIV on barriers faced to initiate ART following HIV testing and referral for treatment. In this qualitative study, we purposively sampled and enrolled 17 patients attending the Mulago ISS clinic. We selected patients (≥18 years) who previously were received as referrals for HIV treatment and had delayed ART initiation, as ascertained from their records. We conducted in-depth interviews, which were audio recorded, transcribed and translated. We used Atlas.ti version 9 software for data management. Data analysis followed thematic and framework analysis techniques and we adopted the socio-ecological model to categorize final themes. Key themes were found at organizational level including; negative experiences at the place of HIV diagnosis attributed to inadequate counselling and support, unclear communication of HIV-positive results and ambiguous referral procedures; and, long waiting time when patients reached the HIV clinic. At individual level, the themes identified were; immediate denial with late acceptance of HIV-positive results attributed to severe emotional and psychological distress at receiving results, fear of perceived side effects and long duration on ART. At interpersonal level, we found that anticipated and enacted stigma after HIV diagnosis resulted in non-disclosure, discrimination and lack of social support. We found that challenges at entry (during HIV test) and navigation of the HIV care system in addition to individual and interpersonal factors contributed to delayed ART initiation. Interventions during HIV testing would facilitate early ART initiation among patients referred for HIV care.
在确诊感染艾滋病毒后尽早开始抗逆转录病毒治疗（ART）可预防艾滋病毒传播、阻止艾滋病毒发展为艾滋病，并改善生活质量。然而，对于在与接受艾滋病毒治疗地点不同的环境中检测出艾滋病毒呈阳性的患者而言，及时开始ART存在哪些障碍，人们却知之甚少，因此这些患者是在常规环境中被转诊的。所以，我们探讨了艾滋病毒感染者对于在艾滋病毒检测及转诊治疗后开始ART所面临障碍的看法。在这项定性研究中，我们有目的地抽取并招募了17名在穆拉戈国际空间站诊所就诊的患者。我们选择了年龄≥18岁、此前作为艾滋病毒治疗转诊患者且从其记录中确定ART启动延迟的患者。我们进行了深入访谈，并进行了录音、转录和翻译。我们使用Atlas.ti 9版本软件进行数据管理。数据分析采用了主题分析和框架分析技术，并且我们采用社会生态模型对最终主题进行分类。在组织层面发现的关键主题包括：在艾滋病毒诊断地点的负面经历，这归因于咨询和支持不足、艾滋病毒检测结果传达不清晰以及转诊程序不明确；以及患者到达艾滋病毒诊所后的漫长等待时间。在个人层面，确定的主题有：对艾滋病毒检测结果立即否认，后期才接受，这归因于收到结果时严重的情绪和心理困扰、对预期副作用的恐惧以及ART疗程较长。在人际层面，我们发现艾滋病毒诊断后预期和实际遭受的耻辱导致了信息不公开、歧视以及缺乏社会支持。我们发现，除了个人和人际因素外，艾滋病毒检测时（进入阶段）以及艾滋病毒护理系统的就医过程中存在的挑战导致了ART启动延迟。艾滋病毒检测期间的干预措施将有助于促进被转诊接受艾滋病毒护理的患者尽早开始ART。
