Ezenduka Johnbaptist, Nwaokennaya Peter, Obasa Gbenga Benjamin, Ogbeke Geoffrey, Onuorah Ogonna, Abubakar Lawal, Bashorun Adebobola, Ogochukwu Ginigeme, Franklin Emerenini, Akinjeji Adewale
ICAP Nigeria, Abuja, Nigeria.
National AIDS and STI Control Program, Ministry of Health, Abuja, Nigeria.
PLoS One. 2025 May 27;20(5):e0309254. doi: 10.1371/journal.pone.0309254. eCollection 2025.
Nigeria, home to approximately 1.9 million people living with HIV (PLHIV), faces significant challenges in providing adequate care and treatment to the teeming number of PLHIV, particularly following the adoption of the 'test and treat' policy and the HIV 'SURGE' initiative. The Differentiated Service Delivery (DSD) model was introduced to address the increased burden on the healthcare system, offering patient-centered care through diverse methods like community-based care, fast-track drug refills, and task-shifting to lower-level healthcare providers. This study, conducted by the National AIDS and STI Control Program (NASCP) in collaboration with ICAP at Columbia University, evaluates the perspectives of healthcare workers and PLHIV on DSD programs in Nigeria. This is a qualitative study involving key informant interviews (KIIs) with 12 healthcare workers and focus group discussions (FGDs) with 153 PLHIV across four Nigerian states (Anambra, Kaduna, Lagos, Taraba). Healthcare workers with at least one year of ART service experience and PLHIV on ART for at least one year with suppressed viral loads were included in the study. Data was analyzed using an inductive, thematic approach to identify emergent patterns and themes. The study revealed that DSD models, such as peer-led Facility ART groups and community pharmacy ART refills, were widely implemented. The primary factors influencing the deployment of DSD models included client convenience and the need to alleviate healthcare worker load. Positive experiences with DSD were associated with convenience, confidentiality, and affordability, whereas negative perceptions stemmed from high service costs, poor healthcare worker attitudes, and confidentiality concerns. Additionally, the study highlighted the necessity for continuous training of healthcare workers, engagement with PLHIV, and increased awareness programs to improve DSD service delivery. Overall, the study underscores the importance of addressing financial barriers, enhancing healthcare worker training, and ensuring confidentiality in optimizing DSD models and improving HIV care outcomes in Nigeria.
尼日利亚约有190万艾滋病毒感染者，在为大量艾滋病毒感染者提供充分护理和治疗方面面临重大挑战，尤其是在采用“检测即治疗”政策和艾滋病毒“激增”倡议之后。引入差异化服务提供（DSD）模式是为了应对医疗系统日益增加的负担，通过社区护理、快速药物补充和任务转移给基层医疗服务提供者等多种方式提供以患者为中心的护理。这项由国家艾滋病和性传播感染控制项目（NASCP）与哥伦比亚大学国际人口与发展政策研究所（ICAP）合作开展的研究，评估了尼日利亚医护人员和艾滋病毒感染者对DSD项目的看法。这是一项定性研究，包括对12名医护人员进行关键信息访谈（KII），以及在尼日利亚四个州（阿南布拉州、卡杜纳州、拉各斯州、塔拉巴州）与153名艾滋病毒感染者进行焦点小组讨论（FGD）。研究纳入了至少有一年抗逆转录病毒治疗服务经验的医护人员以及接受抗逆转录病毒治疗至少一年且病毒载量得到抑制的艾滋病毒感染者。数据采用归纳式主题分析方法进行分析，以识别新出现的模式和主题。研究发现，同伴主导的机构抗逆转录病毒治疗小组和社区药房抗逆转录病毒药物补充等DSD模式得到广泛实施。影响DSD模式部署的主要因素包括客户便利性以及减轻医护人员负担的需求。DSD的积极体验与便利性、保密性和可承受性相关，而负面看法则源于服务成本高、医护人员态度差以及对保密性的担忧。此外，该研究强调了持续培训医护人员、与艾滋病毒感染者互动以及加强宣传项目以改善DSD服务提供的必要性。总体而言，该研究强调了在优化DSD模式和改善尼日利亚艾滋病毒护理结果方面解决经济障碍、加强医护人员培训和确保保密性的重要性。
