肯尼亚基苏穆县艾滋病毒护理差异化服务提供效率和经验:混合方法研究,2014-2021年
Francesca Odhiambo1, Raphael Onyango Mando1, Jayne Lewis-Kulzer2
1Centre for Microbiology Research, Research Care and Training Program, Kenya Medical Research Institute, Nairobi, Kenya.
PLOS global public health
|August 1, 2025
概括
差异化服务交付 (DSD) 模型显著改善了艾滋病毒治疗的保留和病毒载量抑制. 客户和医疗保健工作者报告高满意度,尽管由于对社区模式的耻辱担忧,以设施为基础的DSD更受青.
科学领域:
- 公共卫生 公共卫生
- 传染病流行病学 传染病流行病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 世界卫生组织 (WHO) 2015年测试和治疗政策增加了艾滋病毒感染者 (PLHIV) 获得治疗的人数,使医疗保健系统受到压力.
- 差异化服务交付 (DSD) 被世卫组织认可,以减轻医疗负担,并推动到2030年实现联合国艾滋病规划署95-95-95目标.
研究的目的:
- 评估DSD模型中的客户的临床结果,特别是保留和病毒负载抑制.
- 用DSD方法评估医疗保健工作者和客户的体验.
主要方法:
- 在肯尼亚基苏穆县的14个卫生部设施中进行了客户级预后研究 (2014年10月 - 2021年3月).
- 在三个时间点分析了保留和病毒载荷抑制 (<1000副本/毫升):DSD前,DSD后12个月和DSD后24个月.
- 与成年客户和医疗保健工作者进行了焦点小组讨论 (FGD),以探索他们对DSD的经验.
主要成果:
- 保持率从DSD前的86.4%显著增加到12个月后的99.2%和24个月后的98.9% (p < 0.001).
- FGD显示,客户和医疗保健工作者对DSD的满意度很高,理由是服务效率提高,员工态度改善,工作量减少.
- 客户表示,由于耻辱和隐私问题,他们更喜欢基于设施的DSD模型而不是基于社区的模型.
结论:
- 差异化服务交付 (DSD) 模型在改善持续保留抗逆转录病毒疗法 (ART) 和病毒负载抑制方面表现出显著的有效性.
- 对于以患者为中心的艾滋病毒护理,DSD方法是可以接受的,也是客户的首选.
- 解决耻辱和隐私问题对于优化基于社区的DSD模型至关重要.
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