Aluisio Adam R, Bergam Scarlett J, Kinuthia John, Maina John Wamutitu, Pirirei Sankei, Bukusi David, Waweru Harriet, Bosire Rose, Chen Josephine, Ojuka Daniel K, Katz David A, Farquhar Carey, Mello Michael J, Guthrie Kate M
Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
AIDS Care. 2025 Jan;37(1):112-123. doi: 10.1080/09540121.2024.2414087. Epub 2024 Oct 22.
In Kenya, persons insufficiently engaged in HIV Testing Services (HTS) are often treated in emergency departments (ED). There are limited data from healthcare workers on ED-HTS. A qualitative study was completed to understand challenges and facilitators for ED-HTS and HIV self-testing (HIVST). Data were collected via six focus groups of healthcare workers. Data were inductively analyzed and mapped to the Capability-Opportunity-Motivation Behavioral Model. Focus groups were completed with 49 healthcare workers: 18 nurses, 15 HIV counselors, 10 physicians and 6 administrators. HTS challenges included staff burdens, resources access, deficiencies in systems integration and illness severity. HTS facilitators included education of healthcare workers and patients, services coordination, and specific follow-up processes. HIVST challenges included accuracy concerns, follow-up barriers and psychosocial risks. HIVST facilitators were patient autonomy and confidentiality, resource utilization and ability to reach higher-risk persons. Mapping to the Capability-Opportunity-Motivation Behavioral Model interventions within the domains of knowledge, decision processes, environmental aspects, social influences and professional identities could support enhanced ED-HTS with integrated HIVST delivery. This study provided insights into challenges and facilitators on ED-HTS and identifies pragmatic approaches to improve healthcare workers' behaviors and abilities to provide services to persons already in contact with healthcare.
在肯尼亚，未充分参与艾滋病毒检测服务（HTS）的人员常常在急诊科（ED）接受治疗。来自医护人员的关于急诊科艾滋病毒检测服务的数据有限。一项定性研究已完成，以了解急诊科艾滋病毒检测服务和艾滋病毒自我检测（HIVST）的挑战与促进因素。通过六组医护人员焦点小组收集数据。对数据进行归纳分析，并映射到能力-机会-动机行为模型。与49名医护人员完成了焦点小组讨论：18名护士、15名艾滋病毒咨询员、10名医生和6名管理人员。艾滋病毒检测服务的挑战包括工作人员负担、资源获取、系统整合不足和病情严重程度。艾滋病毒检测服务的促进因素包括对医护人员和患者的教育、服务协调以及特定的后续流程。艾滋病毒自我检测的挑战包括对准确性的担忧、后续障碍和心理社会风险。艾滋病毒自我检测的促进因素是患者自主性和保密性、资源利用以及接触高危人群的能力。映射到能力-机会-动机行为模型，在知识、决策过程、环境因素、社会影响和职业身份等领域的干预措施可支持在提供综合艾滋病毒自我检测服务的同时加强急诊科艾滋病毒检测服务。本研究深入了解了急诊科艾滋病毒检测服务的挑战与促进因素，并确定了务实的方法来改善医护人员的行为和能力，以便为已经与医疗保健机构有接触的人员提供服务。
