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Optimizing differentiated treatment models for people living with HIV in urban Zimbabwe: Findings from a mixed methods study.
Rabkin, Miriam; Strauss, Michael; Mantell, Joanne E; Mapingure, Munyaradzi; Masvawure, Tsitsi B; Lamb, Matthew R; Zech, Jennifer M; Musuka, Godfrey; Chingombe, Innocent; Msukwa, Martin; Boccanera, Rodrigo; Gwanzura, Clorata; George, Gavin; Apollo, Tsitsi.
Afiliação
  • Rabkin M; ICAP at Columbia University, New York, New York, United States of America.
  • Strauss M; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America.
  • Mantell JE; Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa.
  • Mapingure M; Department of Psychiatry, Division of Gender, Sexuality and Health, Columbia University, New York, New York, United States of America.
  • Masvawure TB; The New York State Psychiatric Institute, New York, New York, United States of America.
  • Lamb MR; ICAP at Columbia University, Harare, Zimbabwe.
  • Zech JM; Department of Sociology and Anthropology, College of the Holy Cross, Worcester, Massachusetts, United States of America.
  • Musuka G; ICAP at Columbia University, New York, New York, United States of America.
  • Chingombe I; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America.
  • Msukwa M; ICAP at Columbia University, New York, New York, United States of America.
  • Boccanera R; ICAP at Columbia University, Harare, Zimbabwe.
  • Gwanzura C; ICAP at Columbia University, Harare, Zimbabwe.
  • George G; ICAP at Columbia University, Pretoria, South Africa.
  • Apollo T; Health Resources and Services Administration (HRSA), Bethesda, Maryland, United States of America.
PLoS One ; 15(1): e0228148, 2020.
Article em En | MEDLINE | ID: mdl-31990930
INTRODUCTION: Zimbabwe is scaling up HIV differentiated service delivery (DSD) to improve treatment outcomes and health system efficiencies. Shifting stable patients into less-intensive DSD models is a high priority in order to accommodate the large numbers of newly-diagnosed people living with HIV (PLHIV) needing treatment and to provide healthcare workers with the time and space needed to treat people with advanced HIV disease. DSD is also seen as a way to improve service quality and enhance retention in care. National guidelines support five differentiated antiretroviral treatment models (DART) for stable HIV-positive adults, but little is known about patient preferences, a critical element needed to guide DART scale-up and ensure person-centered care. We designed a mixed-methods study to explore treatment preferences of PLHIV in urban Zimbabwe. METHODS: The study was conducted in Harare, and included 35 health care worker (HCW) key informant interviews (KII); 8 focus group discussions (FGD) with 54 PLHIV; a discrete choice experiment (DCE) in which 500 adult DART-eligible PLHIV selected their preferences for health facility (HF) vs. community location, individual vs. group meetings, provider cadre and attitude, clinic operation times, visit frequency, visit duration and cost to patient; and a survey with the 500 DCE participants exploring DART knowledge and preferences. RESULTS: Patient preferences were consistent in the FGDs, DCE and survey. Participants strongly preferred respectful HCWs, HF-based services, individual DART models, and less costly services. Patients also preferred less frequent visits and shorter wait times. They were indifferent to variations in HCW cadre and distances from home to HF. These preferences were mostly homogenous, with only minor differences between male vs. female and older vs. younger patients. HCWs in the KII correctly characterized facility-based individual models as the one most favored by patients; HCWs also preferred this model, which they felt decongested HFs and reduced their workload. CONCLUSIONS: DART-eligible PLHIV in Harare found it relatively easy to access HFs, and preferred attributes associated with facility-based individual models. Prioritizing these for scale-up in urban areas may be the most efficient way to sustain positive patient outcomes and increase health system performance.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: População Urbana / Infecções por HIV / Fármacos Anti-HIV Tipo de estudo: Diagnostic_studies / Guideline / Prognostic_studies / Qualitative_research Limite: Adolescent / Adult / Female / Humans / Male País como assunto: Africa Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: População Urbana / Infecções por HIV / Fármacos Anti-HIV Tipo de estudo: Diagnostic_studies / Guideline / Prognostic_studies / Qualitative_research Limite: Adolescent / Adult / Female / Humans / Male País como assunto: Africa Idioma: En Ano de publicação: 2020 Tipo de documento: Article