Médecins Sans Frontières, Cape Town, South Africa.
School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Sci Rep. 2024 Mar 27;14(1):7317. doi: 10.1038/s41598-024-57774-9.
Psychosocial challenges impact patients' ability to remain on antiretroviral therapy lifelong, magnified by disorganized health-systems and healthcare worker (HCW) attitudes. To address this, Médecins Sans Frontières and the Department of Health developed the Welcome Service intervention, to provide person-centered care at re-engagement after HIV treatment interruption. Implemented in Khayelitsha, South Africa, between August 2020 and February 2021, the intervention aimed to reorganize triage, optimize clinical and counselling services and address HCW attitudes. The study used a mixed-methods design, incorporating in-depth interviews, and analyses of programmatic and routine health data. Interviews demonstrated positive patient care experiences. HCWs understood the potential impact of attitudes on patient engagement, however, some continued to demonstrate judgmental attitude. Clinical objectives were variably met at re-engagement: 98% were re-initiated the same day, 50% had a CD4 done, and 45% received tuberculosis prevention. Nevertheless, 4-month retention was 66%, and 88% had a VL < 1000 c/mL. Despite HCWs' understanding of person-centered care not translating into supportive behaviors, patients had positive care experiences and the intervention ended with a high rate of VL suppression. More efforts are needed to design interventions building on Welcome Service principles to provide person-centered care and sustain retention after re-engagement.
心理社会挑战影响患者终身坚持抗逆转录病毒治疗的能力，而混乱的卫生系统和医疗工作者（HCW）态度则加剧了这一挑战。为了解决这个问题，无国界医生组织和卫生部制定了欢迎服务干预措施，在 HIV 治疗中断后重新开始治疗时提供以患者为中心的护理。该干预措施于 2020 年 8 月至 2021 年 2 月在南非开普敦实施，旨在重新组织分诊，优化临床和咨询服务，并解决 HCW 的态度问题。该研究采用了混合方法设计，包括深入访谈和对项目和常规卫生数据的分析。访谈表明患者的护理体验良好。HCW 了解态度对患者参与的潜在影响，但有些人仍表现出评判性态度。重新开始治疗时临床目标的实现情况各不相同：98%的患者当天重新开始治疗，50%的患者进行了 CD4 检测，45%的患者接受了结核病预防。然而，4 个月的保留率为 66%，88%的患者病毒载量<1000 拷贝/毫升。尽管 HCW 理解以患者为中心的护理并没有转化为支持性的行为，但患者的护理体验良好，干预结束时病毒载量抑制率很高。需要进一步努力设计基于欢迎服务原则的干预措施，以提供以患者为中心的护理，并在重新开始治疗后维持保留率。
