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Experiences and expectations of patients living with HIV on their engagement with care in Western Kenya

机译：肯尼亚西部艾滋病毒感染者参与护理的经验和期望

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Purpose: In resource-limited HIV care settings, effective and innovative interventions that respond to the existing challenges along the HIV care continuum are urgently needed to realize the benefits of antiretroviral therapy (ART). Initiating effective ART adherence dialog in an environment that promotes patient engagement in care is key. It is therefore critical to enhance our understanding about how patients living with HIV in these regions conceptualize and experience patient engagement. This study explores HIV patients’ perceptions, experiences and expectations of their engagement in care. Materials and methods: We sampled 86 patients from three Academic Model for Providing Access to Healthcare (AMPATH plus ) sites, one urban and two rural. We conducted 24 in-depth interviews and eight focus group discussions in either Swahili or English. Audio recordings of the interviews were transcribed, and then translated into English. We performed content analysis after thematic coding. Results: Patients living with HIV in Kenya desire active engagement with care. However, their engagement was inconsistent and varied depending on the provider. Patients had a sense of how provider’s interpersonal behaviors influenced their level of engagement. These included various aspects of provider–patient communication and relationship dynamics. Patients also highlighted relational boundaries that influenced the level and kind of information they shared with their providers. Aspects of their psychological, social or economic wellbeing were often viewed as personal and not discussed with their clinicians. Patients identified factors that would promote or impede their engagement with care including those related to patients themselves, providers, and the healthcare system. Conclusion: Patients living with HIV desired more active engagement in their care. In addition, they desired clinicians to engage in more social behaviors to promote patient engagement. To address existing patient engagement barriers, HIV care systems in the region should apply contextualized patient-centered interventions.
机译：目的：在资源有限的艾滋病毒治疗环境中，迫切需要有效和创新的干预措施来应对艾滋病毒治疗连续性方面的现有挑战，以实现抗逆转录病毒疗法（ART）的益处。在促进患者参与护理的环境中启动有效的ART依从性对话是关键。因此，至关重要的是，加深我们对这些地区艾滋病毒感染者的观念和患者参与度的了解。这项研究探讨了艾滋病毒患者对从事护理工作的看法，经验和期望。材料和方法：我们从三个提供医疗保健机会的学术模型（AMPATH plus）地点（一个城市和两个农村）中抽取了86名患者作为样本。我们用斯瓦希里语或英语进行了24次深度访谈和8次焦点小组讨论。采访的录音被转录，然后翻译成英语。经过专题编码后，我们进行了内容分析。结果：肯尼亚的HIV感染者希望积极参与护理。但是，他们的参与并不一致，并且取决于提供者。患者对提供者的人际交往行为如何影响他们的参与程度有所了解。其中包括提供者与患者之间的沟通和关系动态的各个方面。患者还强调了关系边界，这些边界会影响他们与提供者共享的信息的水平和种类。他们的心理，社会或经济状况通常被认为是个人的，并未与临床医生讨论。患者确定了会促进或阻碍他们参与护理的因素，包括那些与患者本身，提供者和医疗系统有关的因素。结论：艾滋病毒感染者希望他们的护理更加积极。另外，他们希望临床医生参与更多的社交行为以促进患者参与。为了解决现有的患者参与障碍，该地区的艾滋病毒护理系统应采用以患者为中心的情境干预措施。

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