Bypassing primary antiretroviral therapy centres in Sub-Saharan Africa: An integrative review of the theoretical and empirical literature

IF 3.5 4区 医学 Q2 IMMUNOLOGY
Maximillian Kolbe Domapielle , Sadat Zakari Abugbila , Marshall Kala
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引用次数: 0

Abstract

The uptake of antiretroviral therapy (ART) is critical to meeting the global HIV treatment goal of 95-95-95 by 2025. Although a few Sub-Saharan African countries have already achieved this target, the prevalence of bypassing primary ART centres in many countries in the subregion has negative implications for ART uptake and use. This study used the access to health services framework to analyse the evidence and factors contributing to bypassing primary ART centres by individuals in the sub-region seeking HIV care and support. We found compelling evidence of the prevalence of ART clients bypassing their primary ART centres in search of specialised care in higher-tiered health facilities. Others use bypassing to conceal their HIV-positive status to avoid social stigma. We argue that introducing specialised and differentiated ART at the primary level of care can address this phenomenon. While we anticipate that this measure will satisfy clients' desire for specialised care, we recommend enhancing public awareness about the effectiveness of ART to reduce stigma towards ART clients. Legislation and strict enforcement of anti-HIV stigma laws, which outlaw and criminalise stigmatising people living with HIV (PLHIV), could potentially be an effective stigma-deterring measure. To complement this effort, PLHIV should be empowered to understand legislative instruments and steps to take when confidentiality and discriminatory issues arise. We recommend further research in Sub-Saharan Africa to investigate the relationship between bypassing primary ART centres and client adherence. The findings will help design appropriate strategies to increase ART uptake at primary ART centres.
绕过初级抗逆转录病毒治疗中心在撒哈拉以南非洲:理论和实证文献的综合审查。
接受抗逆转录病毒治疗对于实现到2025年95-95-95全球艾滋病毒治疗目标至关重要。尽管少数撒哈拉以南非洲国家已经实现了这一目标,但该分区域许多国家绕过初级抗逆转录病毒治疗中心的普遍现象对抗逆转录病毒治疗的接受和使用产生了负面影响。本研究使用获得卫生服务框架来分析导致该次区域寻求艾滋病毒护理和支持的个人绕过初级抗逆转录病毒治疗中心的证据和因素。我们发现了令人信服的证据,表明抗逆转录病毒治疗患者普遍绕过其初级抗逆转录病毒治疗中心,在更高级的卫生设施中寻求专业护理。另一些人则通过回避来隐瞒自己的艾滋病毒阳性状况,以避免社会污名。我们认为,在初级保健阶段引入专业化和差异化的抗逆转录病毒治疗可以解决这一现象。虽然我们预计这一措施将满足客户对专业护理的愿望,但我们建议提高公众对抗逆转录病毒治疗有效性的认识,以减少对抗逆转录病毒治疗客户的污名。立法和严格执行反艾滋病毒污名法,将污名化艾滋病毒感染者(PLHIV)定为非法和刑事犯罪,可能是一种有效的阻止污名化的措施。为了补充这一努力,应赋予艾滋病毒感染者了解法律文书和在出现保密和歧视问题时应采取的步骤的权力。我们建议在撒哈拉以南非洲开展进一步研究,以调查绕过初级抗逆转录病毒治疗中心与患者依从性之间的关系。研究结果将有助于制定适当的战略,以增加初级抗逆转录病毒治疗中心对抗逆转录病毒治疗的接受。
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来源期刊
Journal of Virus Eradication
Journal of Virus Eradication Medicine-Public Health, Environmental and Occupational Health
CiteScore
6.10
自引率
1.80%
发文量
28
审稿时长
39 weeks
期刊介绍: The Journal of Virus Eradication aims to provide a specialist, open-access forum to publish work in the rapidly developing field of virus eradication. The Journal covers all human viruses, in the context of new therapeutic strategies, as well as societal eradication of viral infections with preventive interventions. The Journal is aimed at the international community involved in the prevention and management of viral infections. It provides an academic forum for the publication of original research into viral reservoirs, viral persistence and virus eradication and ultimately development of cures. The Journal not only publishes original research, but provides an opportunity for opinions, reviews, case studies and comments on the published literature. It focusses on evidence-based medicine as the major thrust in the successful management of viral infections.The Journal encompasses virological, immunological, epidemiological, modelling, pharmacological, pre-clinical and in vitro, as well as clinical, data including but not limited to drugs, immunotherapy and gene therapy. It is an important source of information on the development of vaccine programs and preventative measures aimed at virus eradication.
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