Health System Responses to Address Treatment Gaps of Unsuppressed Adolescents on HIV Treatment in Public Primary Health Care Facilities in Windhoek, Namibia.

IF 1.5 Q4 INFECTIOUS DISEASES HIV AIDS-Research and Palliative Care Pub Date : 2024-07-10 eCollection Date: 2024-01-01 DOI:10.2147/HIV.S459124
Farai Kevin Munyayi, Brian van Wyk
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Abstract

Background: Adolescents living with HIV (ALHIV) face unique challenges that result in persistent gaps in achieving and maintaining suppressed viral load. Although effective evidence-based interventions to address treatment gaps in adolescents are readily available, health systems in resource-constrained, high HIV prevalence settings are challenged to implement them to achieve epidemic control. Here, we describe the health system responses to address the treatment gap of unsuppressed ALHIV on antiretroviral therapy in Windhoek, Namibia.

Methods: We conducted a qualitative descriptive and exploratory study in Windhoek between June and October 2023. Nineteen purposively selected key informants, ranging from pediatric HIV program managers to healthcare providers, were interviewed. In-depth interviews were audio-recorded and transcribed verbatim. The transcripts were uploaded to ATLAS.ti and subjected to thematic analysis.

Results: The four main themes elucidated challenges related to adherence and retention as well as health system responses in the form of interventions and support programs. The predominant adherence and retention challenges faced by ALHIV were mental health issues, behavioral and medication-related challenges, and inadequate care and social support. The health system responses to the identified challenges included providing psychosocial support, peer support, optimization of treatment and care, and the utilization of effective service delivery models. Key health system support elements identified included adequately capacitated human resources, efficient medication supply chain systems, creating and maintaining an enabling environment for optimum care, and robust monitoring systems as essential to program success.

Conclusion: The health system responses to address the remaining treatment gaps of unsuppressed ALHIV in Windhoek are quite varied and, although evidence-based, appear to be siloed. We recommend harmonized, multifaceted guidance, integrating psychosocial, treatment, care, and peer-led support, and strengthening client-centred differentiated service delivery models for unsuppressed adolescents.

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纳米比亚温得和克公共初级卫生保健机构为解决未接受艾滋病毒治疗的青少年的治疗缺口而采取的卫生系统应对措施》(Health System Responses to Address Treatment Gaps of Unsuppressed Adolescents on HIV Treatment in Public Primary Health Care Facilities in Windhoek, Namibia)。
背景:青少年艾滋病病毒感染者(ALHIV)面临着独特的挑战,导致在实现和维持抑制病毒载量方面持续存在差距。虽然解决青少年治疗差距的有效循证干预措施现成可用,但在资源有限、HIV 感染率高的环境中,卫生系统在实施这些干预措施以实现疫情控制方面面临挑战。在此,我们介绍了纳米比亚温得和克卫生系统为解决接受抗逆转录病毒治疗的未抑制 ALHIV 的治疗缺口而采取的应对措施:我们于 2023 年 6 月至 10 月在温得和克开展了一项定性描述和探索性研究。我们有目的地选择了 19 位关键信息提供者进行了访谈,其中既有儿科艾滋病项目经理,也有医疗服务提供者。对深入访谈进行了录音和逐字记录。笔录上传到 ATLAS.ti,并进行了主题分析:四个主要专题阐明了与坚持治疗和保留治疗相关的挑战,以及卫生系统以干预和支持计划的形式采取的应对措施。ALHIV 在坚持服药和继续服药方面面临的主要挑战是心理健康问题、行为和药物相关挑战以及护理和社会支持不足。卫生系统应对这些挑战的措施包括提供社会心理支持、同伴支持、优化治疗和护理,以及采用有效的服务提供模式。已确定的关键卫生系统支持要素包括能力充足的人力资源、高效的药品供应链系统、创造和维护有利于优化护理的环境,以及对计划成功至关重要的强有力的监测系统:为解决温得和克未受抑制的 ALHIV 剩余的治疗缺口问题,卫生系统采取了多种应对措施,尽管这些措施以证据为基础,但似乎各自为政。我们建议提供统一的、多方面的指导,整合社会心理、治疗、护理和同伴引导支持,并加强以客户为中心的差异化服务模式,为未接受治疗的青少年提供服务。
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来源期刊
CiteScore
3.00
自引率
6.70%
发文量
61
审稿时长
16 weeks
期刊介绍: About Dove Medical Press Dove Medical Press Ltd is part of Taylor & Francis Group, the Academic Publishing Division of Informa PLC. We specialize in the publication of Open Access peer-reviewed journals across the broad spectrum of science, technology and especially medicine. Dove Medical Press was founded in 2003 with the objective of combining the highest editorial standards with the ''best of breed'' new publishing technologies. We have offices in Manchester and London in the United Kingdom, representatives in Princeton, New Jersey in the United States, and our editorial offices are in Auckland, New Zealand. Dr Scott Fraser is our Medical Director based in the UK. He has been in full time clinical practice for over 20 years as well as having an active research interest.
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