Sengupta Debjani, Chandra Archi, Poddar Upasana, Biswas Rahul, Ghosh Pramit, Pal Arkaprovo, Chakraborty Sandipta, Guchait Debjani
Department of Community Medicine, Calcutta National Medical College, Kolkata, West Bengal, India.
Community Medicine, Jagannath Gupta Institute of Medical Sciences, Budgebudge, West Bengal, India.
J Family Med Prim Care. 2025 May;14(5):1657-1661. doi: 10.4103/jfmpc.jfmpc_1533_24. Epub 2025 May 31.
Biobehavioral surveys confirm that HIV prevalence is high or 'concentrated' among 'key populations' (KPs) who have unprotected sexual contacts with multiple partners or who engage in injecting drug use. These populations include female sex workers (FSW), men who have sex with men (MSM), hijra/transgender (TG), and people who inject drugs (PWID). Antiretroviral therapy is offered under the program of National AIDS Control to Seropositive population at the designated center. Other than the stigma of being HIV positive, there is an additional factor present among these groups of people hindering their uptake of antiretroviral therapy.
To identify and quantify the factors causing poor uptake of ART (antiretroviral therapy) among high risk group of subjects receiving antiretroviral therapy, namely, female sex workers (FEW) and intravenous drug users (IDU). A concurrent parallel design of mixed methodology was conducted with integration of the two arms at analysis.
The quantitative arm involves a retrospective cohort analysis of group on ART having "exposure" defined as a period of 1 year. High-risk behavior constituted of exposure involved in commercial sex work and those exposed to intravenous drug usage. The comparator arm was sex-matched cohort who were sero-positive and on ART but did not have an "exposure" to defined high-risk behavior practice for a period of 1 year. The qualitative arm constituted of development of a grounded theory based on thematic analysis from coded transcripts.
Time taken to travel and expenditure incurred therein added with long waiting time compounded with loss of daily wage (reiterated in both arms) emerged to be the most prominent factor.
Monetary incentive for travel, single window service rapid service and process to access drugs from any center (via a central registration system if possible) may be useful.
生物行为学调查证实，在与多个性伴侣进行无保护性行为或从事注射吸毒的“关键人群”中，艾滋病毒感染率很高或呈“集中”态势。这些人群包括女性性工作者、男男性行为者、海吉拉/变性者以及注射吸毒者。在国家艾滋病防治项目下，指定中心为血清阳性人群提供抗逆转录病毒疗法。除了艾滋病毒呈阳性带来的污名外，这些人群中还存在另一个阻碍他们接受抗逆转录病毒疗法的因素。
确定并量化在接受抗逆转录病毒疗法的高危人群（即女性性工作者和静脉吸毒者）中导致抗逆转录病毒疗法（ART）接受率低的因素。采用混合方法的并行设计，并在分析时将两个分支进行整合。
定量分支涉及对接受抗逆转录病毒疗法的人群进行回顾性队列分析，“暴露”定义为1年的时间段。构成暴露的高危行为包括商业性工作和静脉吸毒。对照分支是血清阳性且接受抗逆转录病毒疗法但在1年期间未“暴露”于特定高危行为的性别匹配队列。定性分支由基于编码转录本的主题分析构建扎根理论组成。
出行时间和费用，再加上漫长的等待时间以及日工资损失（两个分支均有提及），成为最突出的因素。
提供出行的金钱激励、单窗口快速服务以及从任何中心获取药物的流程（如有可能，通过中央登记系统）可能会有所帮助。
