提高安大略省艾滋病毒护理级联的障碍和促进因素：混合方法研究。

Barriers and facilitators to improving the cascade of HIV care in Ontario: a mixed method study.

机构信息

Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S4L8, Canada.

Department of Anesthesia, McMaster University, Hamilton, ON, Canada.

出版信息

BMC Health Serv Res. 2024 Jan 10;24(1):48. doi: 10.1186/s12913-023-10481-z.

DOI:10.1186/s12913-023-10481-z

PMID:38200516

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10782539/

Abstract

BACKGROUND

Engagement in care is important for people living with HIV (PLH) to achieve optimal outcomes. Several strategies have been developed to improve client flow through the HIV care cascade, specifically targeting initiation of treatment, adherence to antiretroviral therapy (ART), retention in care, and engagement in care. We have previously identified effective care cascade strategies in a systematic review. Initiation of ART could be improved by mobile health interventions, and changes in healthcare delivery. Adherence to ART could be improved by mobile health interventions, incentives, counselling, and psychotherapy. Retention in care could be improved by mobile health interventions, incentives, education, and electronic interventions. The aim of this study was to investigate barriers and facilitators to implementing these effective interventions in HIV clinics in Ontario, Canada.

METHODS

We conducted a sequential explanatory mixed methods study. In the quantitative strand, we administered a survey to health workers who provide care to PLH to identify barriers and facilitators. In the qualitative strand, we conducted in-depth interviews informed by the theoretical domains framework (TDF) with health workers and with PLH to explain our quantitative findings. Qualitative and quantitative data were merged to create meta-inferences.

RESULTS

Twenty health workers from 8 clinics in 9 cities in Ontario took the survey. Nine PLH and 10 health workers participated in the qualitative interviews. Clinics in Ontario implemented all the effective interventions identified from the literature for initiation of treatment, adherence to ART, and retention in care despite concerns about resources. Barriers to physical and financial access to care, the workload for tailored care, and expertise were identified by both health workers and PLH. Key facilitators were virtual care and client preparedness through education and peer support.

CONCLUSION

Clinics in Ontario appear to implement several evidence-based strategies to improve PLH engagement. There is a need for more health workers with skills to address unique PLH needs. Virtual care is beneficial to both health workers and PLH.

摘要

背景

参与治疗对于感染艾滋病毒（HIV）的人（PLH）实现最佳结果非常重要。已经开发了几种策略来改善 HIV 护理级联中的客户流量，特别是针对治疗的启动、抗逆转录病毒治疗（ART）的依从性、护理保留和参与护理。我们之前在系统评价中确定了有效的护理级联策略。通过移动健康干预和医疗保健提供方式的改变，可以改善 ART 的启动。通过移动健康干预、激励、咨询和心理治疗，可以改善 ART 的依从性。通过移动健康干预、激励、教育和电子干预，可以改善护理保留。本研究旨在调查在加拿大安大略省的 HIV 诊所实施这些有效干预措施的障碍和促进因素。

方法

我们进行了一项顺序解释性混合方法研究。在定量研究中，我们对为 PLH 提供护理的卫生工作者进行了调查，以确定障碍和促进因素。在定性研究中，我们根据理论领域框架（TDF）与卫生工作者和 PLH 进行了深入访谈，以解释我们的定量发现。定性和定量数据合并以创建元推断。

结果

安大略省的 8 家诊所的 20 名卫生工作者参加了调查。9 名 PLH 和 10 名卫生工作者参加了定性访谈。安大略省的诊所尽管对资源存在担忧，但仍实施了文献中确定的所有有效干预措施，用于治疗的启动、ART 的依从性和护理的保留。卫生工作者和 PLH 都发现了与医疗保健相关的身体和财务获取障碍、个性化护理的工作量以及专业知识。关键的促进因素是虚拟护理以及通过教育和同伴支持使客户做好准备。