Summary of thematic findings of the study.

BackgroundIn Ghana, poor treatment adherence among persons living with HIV (PLHIV) affects the effective treatment and management of HIV/AIDS. A key limitation in addressing the antiretroviral therapy (ART) adherence challenge is the skewed nature of the existing literature on the topic, as much of the research on ART adherence has focused on patient-reported experiences, failing to capture the perspectives of healthcare providers involved in ART delivery.ObjectiveWe ascertained healthcare providers’ perspectives on ART adherence among PLHIV and their proffered recommendations for improved ART retention in the Volta Region of Ghana.MethodsA total of eighteen healthcare providers offering ART services to PLHIV in the Volta Region of Ghana were purposefully recruited from five HIV sentinel sites and interviewed. The data was thematically analyzed using ATLAS.ti.ResultsThe health workers’ experiences were categorized under seven thematic areas. These included difficulties in accessing healthcare providers, improvements in adherence to treatment, people who have interrupted treatment often being new clients, general improvements in health outcomes, financial challenges, persistent stigmatization, and varied levels of family awareness about clients’ status. The reasons for treatment interruption were categorized into fifteen areas. These factors included appointment intervals, healthcare workers, medication shortages, long waiting times, clients’ distance from the facility, forgetfulness, drug characteristics, financial challenges, stigmatization, drug side effects, lack of donor support, alternative treatment choices, misconceptions about HIV cures, and the location of the ART clinic within the health facility. Participants recommended making health facilities/ART sites accessible to communities, increased advocacy on HIV by PLHIV, extended appointment intervals, continuous availability of antiretroviral drugs (ARVs), community support in the treatment of HIV, improved counseling, public education on HIV to reduce stigmatization, government support, home dispensing of ARVs, regulating the activities of traditional herbalists and faith-based healers, and the encouragement of religious bodies in ART adherence education for improved ART uptake. The ART-related challenges identified by the healthcare providers should be addressed by both the Ghana Health Service and the Ghana AIDS Commission to improve ART uptake and adherence in the Volta Region and across the country if Ghana is to end the HIV pandemic by 2030, as set by UNAIDS.

研究背景：在加纳，人类免疫缺陷病毒（HIV）感染者（PLHIV）的治疗依从性不佳，严重影响艾滋病（HIV/AIDS）的规范化治疗与疾病管理。当前针对抗反转录病毒治疗（ART）依从性问题的研究存在显著偏倚：绝大多数相关研究均聚焦于患者自述的诊疗经历，未能涵盖参与ART诊疗全流程的医护人员的视角，这是该领域研究的核心局限。
研究目的：本研究旨在明确加纳沃尔特地区医护人员对PLHIV的ART依从性的看法，并梳理其为提升ART治疗留存率所提出的改进建议。
研究方法：本研究从加纳沃尔特地区的5个HIV哨点监测点中，通过目的性抽样招募了18名为PLHIV提供ART服务的医护人员并进行访谈。研究采用ATLAS.ti软件对采集到的访谈数据进行主题分析。
研究结果：医护人员的诊疗相关经历被划分为7个主题类别，具体包括：医护资源获取困难、治疗依从性提升、中断治疗者多为新确诊患者、健康结局总体改善、经济负担沉重、持续存在的HIV污名化现象，以及家属对患者感染状况的知晓程度参差不齐。治疗中断的原因则被归纳为15个类别，分别为：预约间隔设置不合理、医护人员相关因素、药物供应短缺、候诊时间过长、患者往返医疗机构的距离过远、服药遗忘、药物本身特性、经济压力、污名化歧视、药物不良反应、缺乏捐助方支持、存在替代治疗选择、对HIV治愈存在误解，以及ART门诊在医疗机构内的布局位置不佳。参与访谈的医护人员提出了多项针对性改进建议：优化社区可及的医疗机构/ART诊疗点布局、推动PLHIV开展更多HIV相关宣传活动、延长预约间隔时长、确保护理人员可稳定获取抗反转录病毒药物（ARVs）、为HIV治疗提供社区支持体系、优化诊疗咨询服务、开展HIV公众教育以降低社会污名化、争取政府政策与资源支持、提供居家送药服务、规范传统草药师与信仰治疗师的从业行为，以及鼓励宗教机构参与ART依从性教育，以提升ART治疗的接受度。为实现联合国艾滋病规划署（UNAIDS）设定的到2030年终结HIV全球大流行的目标，加纳卫生服务局与加纳艾滋病委员会应协同解决医护人员所识别出的ART相关挑战，以此提升沃尔特地区乃至全国范围内的ART接受度与治疗依从性。