Du Sixian, Niu Haoran, Jiang Feng, Gong Liwen, Zheng Shan, Cui Qi, Yang Xu, He Jiayan, Dai Rongcai, Luo Qilian, Yang Yiqing
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Wubei, 430030, China.
Major Disciplinary Platform Under Double First-Class Initiative for Liberal Arts, Huazhong University of Science and Technology, Wuhan, Wubei, 430030, China.
BMC Infect Dis. 2025 May 9;25(1):687. doi: 10.1186/s12879-025-11087-y.
HIV remains a critical global public health challenge, with 39 million people living with HIV as of 2022 and over 40.4 million lives lost to the epidemic. In China, the burden is similarly significant, with over 1.33 million HIV cases reported as of 2024. The challenges are particularly acute in western regions like Yunnan Province, which face resource limitations, socio-demographic disparities, and a high prevalence of HIV among ethnic minorities.
This study examines the challenges in HIV diagnosis, treatment, and prevention across various institutions in Yunnan Province, including government bodies, hospitals, disease control centers, and primary healthcare institutions. This study aims to identify key challenges in integrating HIV prevention and treatment in China's border mountainous regions to inform targeted strategies for ethnic minority and impoverished communities.
This study adopts a grounded theory approach to explore the systemic, socio-demographic, and cultural barriers impeding the integration of HIV prevention and treatment in M City, a resource-constrained border region in Yunnan Province. From May 2024 to January 2025, a comprehensive review of regional HIV prevention and control literature, alongside relevant World Health Organization (WHO) guidelines, was undertaken to contextualize the research. To capture multi-level insights, semi-structured interviews were conducted between August and December 2024 with 23 purposively selected participants, including individuals living with HIV, village doctors, healthcare providers, and local policymakers. The qualitative data were analyzed through a rigorous three-stage coding process-comprising open coding, axial coding, and selective coding-consistent with grounded theory methodology, to systematically construct and refine conceptual categories underpinning the integration challenges.
This study included 23 participants from Yunnan Province. Through three-level coding, three major themes were identified. In HIV prevention, key challenges included patients' inattention to prevention, difficulties for village doctors in home-based screening, and poor enthusiasm for prevention in hospitals. In HIV treatment, difficulties included limited government support, variability in patients' conditions, poor medication adherence, poor quality of village clinic services, challenges for healthcare staff, uncertain effects of Chinese and Western medicine synergy, and unsmooth referral mechanisms. In integration of HIV prevention and treatment, major issues involved low referral rates, loose inter-agency cooperation, and systemic barriers to integration.
This study highlights the complex challenges in HIV prevention, treatment, and integration in economically underdeveloped regions, emphasizing the need for improved patient awareness, healthcare system efficiency, and cross-institutional collaboration. Future research should focus on multi-center, longitudinal studies and real-world implementation to refine and scale the integration model for sustainable HIV care in these regions.
艾滋病毒仍然是一项严峻的全球公共卫生挑战，截至2022年，有3900万人感染艾滋病毒，该流行病导致超过4040万人死亡。在中国，负担同样沉重，截至2024年报告的艾滋病毒病例超过133万例。在云南省等西部地区，挑战尤为严峻，这些地区面临资源限制、社会人口差异以及少数民族中艾滋病毒的高流行率。
本研究考察了云南省各机构（包括政府机构、医院、疾病控制中心和基层医疗机构）在艾滋病毒诊断、治疗和预防方面面临的挑战。本研究旨在确定在中国边境山区将艾滋病毒预防与治疗相结合的关键挑战，为针对少数民族和贫困社区的有针对性战略提供信息。
本研究采用扎根理论方法，探讨阻碍云南省资源匮乏边境地区M市艾滋病毒预防与治疗相结合的系统性、社会人口和文化障碍。2024年5月至2025年1月，对该地区艾滋病毒预防控制文献以及世界卫生组织（WHO）相关指南进行了全面回顾，以便将研究置于背景之中。为了获取多层次的见解，2024年8月至12月对23名有目的挑选的参与者进行了半结构化访谈，这些参与者包括艾滋病毒感染者、乡村医生、医疗服务提供者和当地政策制定者。通过严格的三阶段编码过程（包括开放编码、轴心编码和选择编码）对定性数据进行分析，该过程与扎根理论方法一致，以系统地构建和完善支撑整合挑战的概念类别。
本研究纳入了来自云南省的23名参与者。通过三级编码，确定了三个主要主题。在艾滋病毒预防方面，关键挑战包括患者对预防的忽视、乡村医生进行居家筛查的困难以及医院预防积极性不高。在艾滋病毒治疗方面，困难包括政府支持有限、患者病情差异、用药依从性差、乡村诊所服务质量差、医护人员面临的挑战、中西医协同效果不确定以及转诊机制不顺畅。在艾滋病毒预防与治疗的整合方面，主要问题包括转诊率低、机构间合作松散以及整合的系统性障碍。
本研究突出了经济欠发达地区在艾滋病毒预防、治疗和整合方面的复杂挑战，强调需要提高患者意识、医疗系统效率以及跨机构合作。未来的研究应侧重于多中心、纵向研究以及实际应用，以完善和推广这些地区可持续艾滋病毒护理的整合模式。
