Makina-Zimalirana Ndinda, Wilkinson Lynne Susan, Grimsrud Anna, Davies Natasha, Mutyambizi Chipo, Jiyane Anele, Buthelezi Fezile, Rees Kate
Anova Health Institute, Johannesburg, South Africa.
International AIDS Society, Cape Town, South Africa.
PLOS Glob Public Health. 2024 Oct 30;4(10):e0003765. doi: 10.1371/journal.pgph.0003765. eCollection 2024.
Re-engagement, which involves bringing individuals who have fallen out of HIV care back into treatment, is important in the ongoing care of individuals with HIV, especially in regions with high prevalence and resource limitations. Despite extensive treatment programs, a significant number of people living with HIV in South Africa disengage from care due to different barriers. To address this, the South African Department of Health (DoH) introduced guidelines to support re-engagement. However, while there is a lot of research on factors leading to disengagement, there is a gap in understanding effective strategies for retaining those who re-engage. The objective of this study is to understand the barriers and facilitators influencing the adoption and scalability of strategies for re-engagement in HIV care. Anova Health Institute, in collaboration with the Johannesburg district DoH, launched the Re-engagement Initiative. This initiative aimed to help healthcare providers better understand and implement re-engagement guidelines through capacity-building, clinical decision support tools, mentorship, and data collection. We conducted a qualitative study across nine primary care facilities in Johannesburg to investigate the perspectives of implementing providers. Data collection involved in-depth interviews using semi-structured guides. The Consolidated Framework for Implementation Research (CFIR) was used to analyse factors influencing implementation. Our study identified several factors affecting the implementation of intervention supporting re-engagement guidelines. Leadership was important for driving organizational change, creating the necessary tension for change, and prioritizing the intervention. Knowledge and beliefs about the intervention were also significant; while most providers understood the initiative's objectives and tools, negative attitudes among some hindered adoption. Empathy for client disengagement motivated some providers, while others did not share this understanding. The belief that job aides and re-engagement forms promoted standardized care and improved documentation was a factor in supporting the initiative. Additionally, the alignment of the intervention with existing guidelines, facility plans, and goals influenced its success and sustainability. Our findings offer valuable insights into the opportunities and challenges of implementing intervention to support re-engagement guidelines. They emphasize the need to address negative provider attitudes, foster engaged leadership, and integrate initiatives with broader HIV care program and facility workflows. These insights are important for the adoption and implementation of similar guidelines in similar settings.
重新参与，即让脱离艾滋病毒治疗的个体重新接受治疗，在艾滋病毒感染者的持续护理中至关重要，尤其是在高流行率和资源有限的地区。尽管有广泛的治疗项目，但南非仍有大量艾滋病毒感染者因各种障碍而脱离护理。为解决这一问题，南非卫生部出台了支持重新参与的指导方针。然而，虽然有很多关于导致脱离护理因素的研究，但在理解留住重新参与治疗者的有效策略方面存在差距。本研究的目的是了解影响艾滋病毒护理重新参与策略采用和推广的障碍及促进因素。阿诺瓦健康研究所与约翰内斯堡地区卫生部合作发起了重新参与倡议。该倡议旨在通过能力建设、临床决策支持工具、指导和数据收集，帮助医疗服务提供者更好地理解和实施重新参与指导方针。我们在约翰内斯堡的九个初级保健机构开展了一项定性研究，以调查实施提供者的观点。数据收集采用半结构化指南进行深入访谈。实施研究综合框架（CFIR）用于分析影响实施的因素。我们的研究确定了几个影响支持重新参与指导方针干预措施实施的因素。领导力对于推动组织变革、营造变革所需的紧迫感以及优先考虑干预措施很重要。对干预措施的知识和信念也很重要；虽然大多数提供者理解该倡议的目标和工具，但一些人的消极态度阻碍了采用。对客户脱离护理的同理心激励了一些提供者，而其他人则没有这种理解。认为工作辅助工具和重新参与表格促进了标准化护理并改善了文档记录，这是支持该倡议的一个因素。此外，干预措施与现有指南、机构计划和目标的一致性影响了其成功和可持续性。我们的研究结果为实施支持重新参与指导方针的干预措施的机遇和挑战提供了宝贵见解。它们强调需要解决提供者的消极态度，培养积极参与的领导力，并将倡议与更广泛的艾滋病毒护理项目和机构工作流程相结合。这些见解对于在类似环境中采用和实施类似指南很重要。
