Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi.
Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland.
BMC Health Serv Res. 2024 Feb 26;24(1):244. doi: 10.1186/s12913-024-10700-1.
Despite tremendous progress in antiretroviral therapy (ART) and access to ART, many patients have advanced human immunodeficiency virus (HIV) disease (AHD). Patients on AHD, whether initiating ART or providing care after disengagement, have an increased risk of morbidity and mortality. The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) launched an enhanced care package using a hub-and-spoke model to optimize AHD care in Malawi. This model improves supply availability and appropriate linkage to care. We utilized a hub-and-spoke model to share health facility challenges and recommendations on the AHD package for screening and diagnosis, prophylaxis, treatment, and adherence support.
This qualitative study assessed the facility-level experiences of healthcare workers (HCWs) and lay cadres (LCs) providing AHD services to patients through an intervention package. The study population included HCWs and LCs supporting HIV care at four intervention sites. Eligible study participants were recruited by trained Research Assistants with support from the health facility nurse to identify those most involved in supporting patients with AHD. A total of 32 in-depth interviews were conducted. Thematic content analysis identified recurrent themes and patterns across participants' responses.
While HCWs and LCs stated that most medications are often available at both hub and spoke sites, they reported that there are sometimes limited supplies and equipment to run samples and tests necessary to provide AHD care. More than half of the HCWs stated that AHD training sufficiently prepared them to handle AHD patients at both the hub and spoke levels. HCWs and LCs reported weaknesses in the patient referral system within the hub-and-spoke model in providing a linkage of care to facilities, specifically improper referral documentation, incorrect labeling of samples, and inconsistent availability of transportation. While HCWs felt that AHD registers were time-consuming, they remained motivated as they thought they provided better patient services.
These findings highlight the importance of offering comprehensive AHD services. The enhanced AHD program addressed weaknesses in service delivery through decentralization and provided services through a hub-and-spoke model, improved supply availability, and strengthened linkage to care. Additionally, addressing the recommendations of service providers and patients is essential to improve the health and survival of patients with AHD.
尽管抗逆转录病毒疗法（ART）取得了巨大进展，并且能够获得 ART，但许多患者仍患有晚期人类免疫缺陷病毒（HIV）疾病（AHD）。处于 AHD 阶段的患者，无论是开始接受 ART 治疗还是在脱离治疗后提供护理，其发病率和死亡率都有所增加。伊丽莎白·格拉泽儿科艾滋病基金会（EGPAF）推出了一个强化护理包，采用中心辐射模型来优化马拉维的 AHD 护理。该模型提高了供应的可用性和适当的护理衔接。我们利用中心辐射模型就 AHD 套餐的筛查和诊断、预防、治疗和遵医嘱支持方面的卫生机构挑战和建议进行分享。
这项定性研究通过一个干预包评估了向 AHD 患者提供服务的医疗保健工作者（HCWs）和基层人员（LCs）的机构层面经验。研究人群包括在四个干预点支持 HIV 护理的 HCWs 和 LCs。经过培训的研究助理在卫生机构护士的支持下，招募符合条件的研究参与者，以确定那些最能支持 AHD 患者的人。共进行了 32 次深入访谈。主题内容分析确定了参与者回答中反复出现的主题和模式。
虽然 HCWs 和 LCs 表示大多数药物通常在中心和辐射点都有供应，但他们报告说有时供应和设备有限，无法运行提供 AHD 护理所需的样本和测试。超过一半的 HCWs 表示，AHD 培训足以使他们能够在中心和辐射点处理 AHD 患者。HCWs 和 LCs 报告说，在中心辐射模型中，患者转介系统在为设施提供护理衔接方面存在弱点，具体表现为转介文件不正确、样本标签不正确以及交通服务不一致。虽然 HCWs 认为 AHD 登记册很耗时，但他们仍然有动力，因为他们认为这为患者提供了更好的服务。
这些发现强调了提供全面 AHD 服务的重要性。强化的 AHD 计划通过权力下放解决了服务提供方面的弱点，并通过中心辐射模型提供服务，提高了供应的可用性，并加强了护理衔接。此外，解决服务提供者和患者的建议对于改善 AHD 患者的健康和生存至关重要。
