Drosin M. Mulenga, BSW, is a Program Officer, Population Council, Lusaka, Zambia. Joseph G. Rosen, PhD, MSPH, is a Assistant Scientist, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. Lunda Banda, BA, is a Program Officer, Population Council, Lusaka, Zambia. Maurice Musheke, PhD, MPH, is a Research Manager, Population Council, Lusaka, Zambia. Michael T. Mbizvo, PhD, MPhil, MSc, is a Senior Associate, Population Council, Lusaka, Zambia. Henry F. Raymond, DrPH, MPH, is a Associate Professor, Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, New Jersey, USA. Ryan Keating, MPH, is a Program Manager, Institute for Global Health Sciences, University of California, San Francisco, California, USA. Harold Witola, PhD, MSc, is a Director of Programs, National HIV/AIDS/STI/TB Council, Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia. Lyson Phiri, BS, is a Program Officer, Population Council, Lusaka, Zambia. Scott Geibel, PhD, MPH, is a Senior Associate, Population Council, Washington, District of Columbia, USA. Waimar Tun, PhD, MHS, is a Senior Associate, Population Council, Washington, District of Columbia, USA, Nanlesta Pilgrim, PhD, MPH, is a Senior Associate, Population Council, Washington, District of Columbia, USA.
J Assoc Nurses AIDS Care. 2024;35(1):27-39. doi: 10.1097/JNC.0000000000000443. Epub 2023 Nov 29.
Key populations (KPs) experience suboptimal outcomes along the HIV care and prevention continua, but there is limited study of the challenges service providers encounter delivering HIV services to KPs, particularly in settings like Zambia, where provision of these services remains legally ambiguous. Seventy-seven providers completed in-depth interviews exploring constraints to HIV service delivery for KPs and recommendations for improving access and care quality. Thematic analysis identified salient challenges and opportunities to service delivery and quality of care for KPs, spanning interpersonal, institutional, and structural domains. Limited provider training in KP-specific needs was perceived to influence KP disclosure patterns in clinical settings, impeding service quality. The criminalization of KP sexual and drug use behaviors, coupled with perceived institutional and legal ambiguities to providing HIV services to KPs, cultivated unwelcoming service delivery environments for KPs. Findings elucidate opportunities for improving HIV service delivery/quality, from decentralized care to expanded legal protections for KPs and service providers.
重点人群（KPs）在艾滋病毒护理和预防连续体方面的结果并不理想，但对于服务提供者在向 KPs 提供艾滋病毒服务方面所面临的挑战的研究有限，特别是在像赞比亚这样的环境中，这些服务的提供仍然在法律上存在模糊性。77 名提供者完成了深入访谈，探讨了向 KPs 提供艾滋病毒服务的限制因素以及改善获取途径和护理质量的建议。主题分析确定了向 KPs 提供服务和护理质量的突出挑战和机会，涵盖了人际、机构和结构领域。据认为，服务提供者在 KPs 特定需求方面的培训有限，这影响了临床环境中 KPs 的披露模式，阻碍了服务质量。将 KPs 的性和吸毒行为定为犯罪，再加上向 KPs 提供艾滋病毒服务的机构和法律模糊性，使 KPs 面临不受欢迎的服务提供环境。研究结果阐明了从分散护理到扩大 KPs 和服务提供者的法律保护，改善艾滋病毒服务提供/质量的机会。
