关于马来西亚在注射吸毒者中开展当日抗逆转录病毒治疗的障碍和潜在解决办法的实施前调查结果

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-08-26 DOI:10.1016/j.drugpo.2025.104967

David Oliveros , Grazele Jenarun , N.A. Mohd Salleh , Rumana Saifi , Valerie A. Earnshaw , Lynn M. Madden , Daniel J. Bromberg , Ryan A. Sutherland , Benjamin M. Nikitin , Adeeba Kamarulzaman , Frederick L. Altice

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引用次数: 0

摘要

快速启动抗逆转录病毒治疗（RS-ART），包括当日抗逆转录病毒治疗（SD-ART），通过加速治疗启动有效改善了个人和公众健康，但在注射吸毒者（PWID）中未得到充分利用。作为实施前的一项活动，我们利用来自多个利益相关者的见解，评估了马来西亚PWID的SD-ART障碍和促进因素。方法我们采用名义群体技术（NGT）进行焦点小组（n = 4），这是一种混合方法的研究策略，参与者包括马来西亚大吉隆坡的PWID、艾滋病毒专家和社区卫生工作者（chw）。这种方法包括开放式问题、想法的循环列表和参与者投票，根据社会生态模型组织，得出对主要实施障碍和促进因素的排序共识。结果在PWID （n = 5:15票）中，排名最高的障碍包括害怕警察（40%），程序复杂性（30%）和与艾滋病毒提供者不舒服（27%）。艾滋病毒专家（n = 12: 36票）将治疗准备程度（27%）、机会性感染风险（20%）和监禁问题（13%）列为主要障碍。卫生保健工作者（n = 7: 21票）指出，复杂的预约系统（33%）、确认性测试的延误（19%）和与临床医生加强耻辱感的互动（19%）是障碍。促进PWID的因素包括在审查结果之前启动抗逆转录病毒治疗（27%）和当日咨询（27%）。对于艾滋病毒专家来说，重要的战略是加强非政府组织的伙伴关系（33%）和扩大抗逆转录病毒治疗方案，如dolutegravir（20%）。卫生保健工作者建议简化治疗过程（33%）和建立专门的艾滋病毒服务诊所（29%）。结论尽管有减少危害和艾滋病毒治疗服务，但结构和人际耻辱显著阻碍了马来西亚PWID患者接受SD-ART治疗。通过量身定制的抗逆转录病毒治疗启动战略解决耻辱感问题对于缩小这一实施差距至关重要。

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Pre-implementation findings on the barriers and potential solutions to initiate same-day antiretroviral therapy among people who inject drugs in Malaysia

Background

Rapid-start antiretroviral therapy (RS-ART), including same-day ART (SD-ART), effectively improves individual and public health by speeding up treatment initiation but is underutilized among people who inject drugs (PWID). As a pre-implementation activity, we assessed barriers and facilitators to SD-ART for PWID in Malaysia using insights from multiple stakeholders.

Methods

We conducted focus groups (n = 4) using nominal group technique (NGT), a mixed-methods research strategy, with PWID, HIV specialists, and community health workers (CHWs) in Greater Kuala Lumpur, Malaysia. This method involved open questions, round-robin listing of ideas, and participant voting to derive a rank-ordered consensus on major implementation barriers and facilitators, organized according to the socioecological model.

Results

Among PWID (n = 5: 15 votes), the highest-ranking barriers included fear of police (40 %), procedural complexity (30 %), and discomfort with HIV providers (27 %). HIV specialists (n = 12: 36 votes) ranked readiness for treatment (27 %), risk of opportunistic infections (20 %), and incarceration concerns (13 %) as key barriers. CHWs (n = 7: 21 votes) pointed to complex appointment systems (33 %), delays in confirmatory testing (19 %), and stigma-reinforcing interactions with clinicians (19 %) as obstacles. Facilitators for PWID included initiating ART before reviewing results (27 %) and same-day counseling (27 %). For HIV specialists, essential strategies were enhancing NGO partnerships (33 %) and expanding ART options like dolutegravir (20 %). CHWs recommended simplifying treatment processes (33 %) and creating a dedicated clinic for HIV services (29 %).

Conclusion

Despite available harm reduction and HIV treatment services, structural and interpersonal stigma significantly hinder SD-ART initiation among PWID in Malaysia. Addressing stigma through tailored ART initiation strategies is crucial for closing this implementation gap.

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.