Makerere University Joint AIDS Program (MJAP), Kampala, Uganda.
Department of Community Health and Behavioural Sciences, College of Health Sciences, Makerere University School of Public Health, Kampala, Uganda.
BMC Health Serv Res. 2023 Oct 26;23(1):1165. doi: 10.1186/s12913-023-10182-7.
Community Client-Led ART Delivery (CCLAD) is a community HIV care model. In this model, a group of persons living with HIV (PLHIV) in a specific location, take turns going to the HIV clinic to pick up Antiretroviral Treatment refills for members. The uptake of this model, however, remains low despite its improvements in patient retention. In this study, we explored PLHIV's perceptions of this model and identified the factors associated with its low uptake.
This was a mixed methods study based on a retrospective review of records of PLHIV and in-depth interviews. We reviewed the medical records of people receiving ART to determine their current model of ART delivery and conducted in-depth interviews with 30 participants who were eligible to be enrolled in the CCLAD model at the Mulago ISS clinic. We performed logistic regression to identify factors associated with the uptake of the CCLAD model and inductive thematic analysis to explore PLHIV's perceptions of the CCLAD model.
A total of 776 PLHIV were sampled for the study, 545 (70.2%) of whom were female. The mean age (standard deviation) was 42 (± 9.3) years. Overall, 55 (7.1%) received ART using the CCLAD model. Compared to other ART-delivery models, CCLAD was associated with being on ART for at least eight years (AOR 3.72; 95% CI: 1.35-10.25) and having no prior missed clinic appointments (AOR 10.68; 95% CI: 3.31-34.55). Mixed perceptions were expressed about the CCLAD model. Participants interviewed appreciated CCLAD for its convenience and the opportunities it offered members to talk and support each other. Others however, expressed concerns about the process of group formation, and feeling detached from the health facility with consequences of lack of confidentiality.
The current uptake of the CCLAD model is lower than the national recommended percentage of 15%. Its uptake was associated with those who had been in care for a longer period and who did not miss appointments. Despite CCLAD being perceived as convenient and as promoting support among members, several challenges were expressed. These included complexities of group formation, fear of stigma and feelings of detachment from health facilities among others. So, while CCLAD presents a promising alternative ART delivery model, more attention needs to be paid to the processes of group formation and improved patient monitoring to address the feelings of detachment from the facility and facility staff.
社区主导的抗逆转录病毒治疗方案（CCLAD）是一种社区艾滋病护理模式。在这种模式下，特定地点的一群艾滋病毒感染者（PLHIV）轮流到艾滋病诊所为成员领取抗逆转录病毒治疗药物。尽管这种模式提高了患者的保留率，但它的采用率仍然很低。在这项研究中，我们探讨了 PLHIV 对该模式的看法，并确定了与低采用率相关的因素。
这是一项基于对 PLHIV 病历回顾和深入访谈的混合方法研究。我们回顾了接受抗逆转录病毒治疗的人的病历，以确定他们当前的抗逆转录病毒治疗方案，并对 30 名有资格在穆拉戈综合服务诊所参加 CCLAD 模式的参与者进行了深入访谈。我们进行了逻辑回归分析，以确定与 CCLAD 模式采用相关的因素，并进行了归纳主题分析，以探讨 PLHIV 对 CCLAD 模式的看法。
共有 776 名 PLHIV 参加了这项研究，其中 545 名（70.2%）为女性。平均年龄（标准差）为 42（±9.3）岁。总体而言，55 名（7.1%）接受了 CCLAD 模式的抗逆转录病毒治疗。与其他抗逆转录病毒治疗模式相比，CCLAD 与接受抗逆转录病毒治疗至少八年（优势比 3.72；95%置信区间：1.35-10.25）和无既往错过诊所预约（优势比 10.68；95%置信区间：3.31-34.55）相关。对 CCLAD 模式表达了混合看法。接受采访的参与者对 CCLAD 模式的便利性及其为成员提供交流和相互支持的机会表示赞赏。然而，其他人则对小组形成的过程表示担忧，并感到与医疗机构脱节，导致保密性不足。
目前，CCLAD 模式的采用率低于全国推荐的 15%。其采用与那些已经接受治疗较长时间且没有错过预约的患者有关。尽管 CCLAD 被认为方便，并促进了成员之间的支持，但也表达了一些挑战。这些挑战包括小组形成的复杂性、对污名的恐惧以及与医疗机构分离的感觉等。因此，虽然 CCLAD 提供了一种有前途的替代抗逆转录病毒治疗方案，但需要更加关注小组形成的过程和改进患者监测，以解决与医疗机构和医务人员脱节的问题。
