HIV care experiences and health priorities during the first wave of COVID-19: clients’ perspectives – a qualitative study in Lusaka, Zambia

BMC Public Health

Research

Charles B. Holmes¹  Katerina Christopoulos²  Sandra Simbeza³  Izukanji Sikazwe³  Carolyn Bolton-Moore³  Chanda Mwamba³  Kasapo Lumbo³  Marksman Foloko³  Anjali Sharma³  Njekwa Mukamba³  Herbert Nyirenda³  Kombatende Sikombe⁴  Elvin H. Geng⁵  Laura K. Beres⁶ 

[1] Centre for Global Health and Quality, Georgetown University Medical Center, Washington, DC, USA;Department of Medicine, University of California San Francisco, San Francisco, CA, USA;Department of Research, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;Department of Research, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;London School of Hygiene and Tropical Medicine, London, UK;Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA;Division of Social and Behavioural Interventions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;

关键词: COVID-19;    PLHIV;    HIV care experience;    Person-centred care;    Zambia;   

DOI  :  10.1186/s12889-022-14493-y

 received in 2022-06-20, accepted in 2022-10-31,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThe novel COVID-19 pandemic threatened to disrupt access to human immunodeficiency (HIV) treatment for persons living with HIV (PLHIV), two-thirds of whom live in sub-Saharan Africa. To inform a health system response supportive of continuity of care, we sought to understand clients’ HIV care experiences and health priorities during the first wave of COVID-19 outbreak in Lusaka, Zambia.MethodsLeveraging a study cohort of those who completed periodic SMS surveys on HIV care, we purposefully sampled 25 PLHIV after first confirmed COVID-19 case was reported in Zambia on 18th March 2020. We phone-interviewed participants, iteratively refining interview guide to capture emergent themes on COVID-19 awareness, health facility interactions, and social circumstances, which we analyzed using matrix analysis.ResultsAll participants were aware of COVID-19, and HIV care experiences and health priorities of clients were affected by associated changes at health system, household, and individual level. The health system instituted early clinic visits to provide 6-months of antiretroviral therapy (ART) for stable patients and 3-months for unstable patients to reduce clinic visits and wait times. Most patients welcomed this long-desired extended appointment spacing. Some reported feeling respected and engaged when health care workers telephoned requesting their early clinic visit. However, others felt discouraged by an absence of physical distancing during their clinic visit due to ‘severe acute respiratory syndrome coronavirus 2’ (SARS-CoV-2) infection concerns. Several expressed a lack of clarity regarding next viral load monitoring date and means for receiving results. Patients suggested regular patient-facility communication by telephone and SMS. Patients emphasized that COVID-19 restrictions led to loss of employment and household income, exacerbating poverty and difficulties in taking ART. At individual level, most participants felt motivated to stay healthy during COVID-19 by ART adherence and regular laboratory monitoring.ConclusionsClients’ HIV care and health priorities during the first wave of COVID-19 in Lusaka province were varied with a combination of positive and negative experiences that occurred especially at health system and individual levels, while at household level, the experiences were all negative. More research is needed to understand how patients practice resiliency in the widespread context of socio-economic instability. Governments and patients must work together to find local, health systems solutions to support ART adherence and monitoring. Additionally, the health system should consider how to build on changes for long-term HIV management and service delivery.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

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