دورية أكاديمية
أعرض في EDS

Patient and health worker experiences of differentiated models of care for stable HIV patients in Malawi: A qualitative study.

التفاصيل البيبلوغرافية
العنوان: Patient and health worker experiences of differentiated models of care for stable HIV patients in Malawi: A qualitative study.
المؤلفون: Prust ML; Applied Analytics Team, Clinton Health Access Initiative, Inc., Boston, MA, United States of America., Banda CK; Clinton Health Access Initiative, Inc., Lilongwe, Malawi., Callahan K; HIV, TB and Health Financing Team, Clinton Health Access Initiative, Inc., New York, NY, United States of America., Nyirenda R; Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi., Chimbwandira F; Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi., Kalua T; Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi., Eliya M; Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi., Ehrenkranz P; Bill & Melinda Gates Foundation, Seattle, WA, United States of America., Prescott M; Applied Analytics Team, Clinton Health Access Initiative, Inc., Boston, MA, United States of America., McCarthy E; Applied Analytics Team, Clinton Health Access Initiative, Inc., Boston, MA, United States of America., Tagar E; HIV, TB and Health Financing Team, Clinton Health Access Initiative, Inc., New York, NY, United States of America., Gunda A; Clinton Health Access Initiative, Inc., Lilongwe, Malawi.
المصدر: PloS one [PLoS One] 2018 Jul 19; Vol. 13 (7), pp. e0196498. Date of Electronic Publication: 2018 Jul 19 (Print Publication: 2018).
نوع المنشور: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
أسماء مطبوعة: Original Publication: San Francisco, CA : Public Library of Science
مواضيع طبية MeSH: Models, Organizational*, Anti-HIV Agents/*supply & distribution , Delivery of Health Care/*methods , HIV Infections/*psychology , Health Personnel/*psychology , Outpatients/*psychology , Prescription Drug Monitoring Programs/*statistics & numerical data, Adult ; Anti-HIV Agents/therapeutic use ; Antiretroviral Therapy, Highly Active ; Female ; Focus Groups ; HIV Infections/drug therapy ; Humans ; Malawi ; Male ; Middle Aged ; Patient Satisfaction/statistics & numerical data ; Qualitative Research ; Social Support ; Surveys and Questionnaires
مستخلص: Introduction: Several models of differentiated care for stable HIV patients on antiretroviral therapy (ART) in Malawi have been introduced to ensure that care is efficient and patient-centered. Three models have been prioritized by the government for a deeper and broader understanding: adjusted appointment spacing through multi-month scripting (MMS); fast-track drug refills (FTRs) on alternating visits; and community ART groups (CAGs) where rotating group members collect medications at the facility for all members. This qualitative study aimed to understand the challenges and successes of implementing these models of care and of the process of patient differentiation.
Methods: A qualitative study was conducted as a part of a broader process evaluation in 30 purposefully selected ART facilities between February and May 2016. Semi-structured, in-depth interviews with 32 health workers that managed and coordinated ART clinics and 30 focus groups were held with 216 ART patients. Interviews and focus groups were audio recorded, transcribed, and coded thematically.
Results: Participants reported that the models of differentiated care have yielded key benefits, including: reduced patients' travel and visit time, decongestion of facilities, and enhanced social support. Participants suggested that these benefits could lead to improved HIV treatment outcomes for patients. At the same time, some challenges were reported, such as inconsistent stocks of drugs, which can inhibit implementation of MMS. For CAGs, the group-based nature of the model presented some unique problems, such as conflicts within groups or concerns about privacy. Health workers also described some of the reasons why eligible patients may not receive the models or conversely why ineligible patients sometimes get the models.
Conclusions: Documenting patient and health worker perspectives on models of differentiated care is critical to understanding and improving these models. While these models can offer important benefits, the models may not be appropriate for all sites or patients, and patient status and needs may change over time. Key challenges should be recognized and addressed for optimal utilization of the models.
Competing Interests: The authors have declared that no competing interests exist.
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المشرفين على المادة: 0 (Anti-HIV Agents)
تواريخ الأحداث: Date Created: 20180720 Date Completed: 20181226 Latest Revision: 20181226
رمز التحديث: 20240628
مُعرف محوري في PubMed: PMC6053133
DOI: 10.1371/journal.pone.0196498
PMID: 30024874
قاعدة البيانات: MEDLINE
الوصف
تدمد:1932-6203
DOI:10.1371/journal.pone.0196498