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Engaging HIV-positive clients in care: acceptability and mechanisms of action of a peer navigation program in South Africa

机译：艾滋病毒阳性客户在护理中：南非对等导航计划的可接受性和行动机制

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Antiretroviral therapy (ART) could curtail the HIV epidemic, but its impact is diminished by low uptake. We developed a peer navigation program to enhance engagement in HIV care, ART adherence, and behavioral prevention. In preparation for a randomized controlled trial, the program was piloted over four months at two primary health clinics in South Africa's North West Province. Newly diagnosed, HIV-positive clients met regularly with navigators to address barriers to care, adherence, and prevention. To assess program acceptability and feasibility and characterize the mechanisms of action, we surveyed 25 clients who completed navigation services and conducted interviews with 10 clients, four navigators, and five clinic providers. Clients expressed near universal approval for the program and were satisfied with the frequency of contact with navigators. HIV stigma emerged as a primary driver of barriers to care. Navigators helped clients overcome feelings of shame through education and by modeling how to live successfully with HIV. They addressed discrimination fears by helping clients disclose to trusted individuals. These actions, in turn, facilitated clients' care engagement, ART adherence, and HIV prevention efforts. The findings suggest peer navigation is a feasible approach with potential to maximize the impact of ART-based HIV treatment and prevention strategies.
机译：抗逆转录病毒治疗（ART）可能会削减艾滋病毒流行病，但其影响降低了低吸收。我们开发了一个同行导航计划，以增强艾滋病毒护理，艺术遵守和行为预防的参与。为准备随机对照试验，该计划在南非西部省的两次初级健康诊所试用了四个月。新诊断出的艾滋病毒阳性客户经常与导航员达到满足护理，遵守和预防的障碍。为了评估程序可接受性和可行性以及表征行动机制，我们调查了25个完成导航服务的客户，并与10个客户，四个导航员和五个诊所提供者进行采访。客户在普遍批准方案附近表示，并对与导航员接触的频率感到满意。 HIV STIGMA成为照顾障碍的主要驾驶员。导航员帮助客户通过教育来克服羞耻感，并通过艾滋病病毒培养成功生活。他们通过帮助客户披露给值得信赖的个人来解决歧视恐惧。反过来，这些行动促进了客户的护理参与，艺术遵守和艾滋病毒预防努力。调查结果表明对等导航是一种可行的方法，具有最大化艺术艾滋病毒治疗和预防策略的影响。

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