"I feel drug resistance testing allowed us to make an informed decision": qualitative insights on the role of HIV drug resistance mutation testing among children and pregnant women living with HIV in western Kenya.

Autor: Scallon AJ; Jackson School of International Studies, University of Washington, Seattle, USA., Hassan SA; Department of Medicine, University of Washington, 325 9th Ave, Seattle, WA, 98105, USA., Qian SR; School of Public Health, University of Washington, Seattle, USA., Gao Y; School of Public Health, University of Washington, Seattle, USA., Oyaro P; Health Innovations Kenya (HIK), Kisumu, Kenya., Brown E; UW Kenya, Nairobi, Kenya., Wagude J; Department of Health, Siaya County, Kenya., Mukui I; Drugs for Neglected Diseases Initiative, Nairobi, Kenya., Kinywa E; Department of Health, Kisumu County, Kenya., Oluoch F; Department of Health, Siaya County, Kenya., Odhiambo F; Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya., Oyaro B; Kenya Medical Research Institute-CDC, Kisian, Kenya., Kingwara L; National HIV Reference Laboratory, Ministry of Health, Nairobi, Kenya., Yongo N; UW Kenya, Nairobi, Kenya., Karauki E; UW Kenya, Nairobi, Kenya., Otieno L; Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya., John-Stewart GC; Department of Medicine, University of Washington, 325 9th Ave, Seattle, WA, 98105, USA.; Departments of Global Health, University of Washington, 325 9th Ave, WA, 98105, Seattle, USA.; Department of Pediatrics, University of Washington, Seattle, USA.; Department of Epidemiology, University of Washington, Seattle, USA., Abuogi LL; Department of Pediatrics, University of Colorado, Denver, USA., Patel RC; Department of Medicine, University of Washington, 325 9th Ave, Seattle, WA, 98105, USA. rcpatel@uw.edu.; Departments of Global Health, University of Washington, 325 9th Ave, WA, 98105, Seattle, USA. rcpatel@uw.edu.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2023 Aug 24; Vol. 23 (1), pp. 908. Date of Electronic Publication: 2023 Aug 24.
DOI: 10.1186/s12913-023-09804-x
Abstrakt: Background: Pregnant women and children living with HIV in Kenya achieve viral suppression (VS) at lower rates than other adults. While many factors contribute to these low rates, the acquisition and development of HIV drug resistance mutations (DRMs) are a contributing factor. Recognizing the significance of DRMs in treatment decisions, resource-limited settings are scaling up national DRM testing programs. From provider and patient perspectives, however, optimal ways to operationalize and scale-up DRM testing in such settings remain unclear.
Methods: Our mixed methods study evaluates the attitudes towards, facilitators to, and barriers to DRM testing approaches among children and pregnant women on antiretroviral therapy (ART) in five HIV treatment facilities in Kenya. We conducted 68 key informant interviews (KIIs) from December 2019 to December 2020 with adolescents, caregivers, pregnant women newly initiating ART or with a high viral load, and providers, laboratory/facility leadership, and policy makers. Our KII guides covered the following domains: (1) DRM testing experiences in routine care and through our intervention and (2) barriers and facilitators to routine and point-of-care DRM testing scale-up. We used inductive coding and thematic analysis to identify dominant themes with convergent and divergent subthemes.
Results: The following themes emerged from our analysis: (1) DRM testing and counseling were valuable to clinical decision-making and reassuring to patients, with timely results allowing providers to change patient ART regimens faster; (2) providers and policymakers desired an amended and potentially decentralized DRM testing process that incorporates quicker sample-to-results turn-around-time, less burdensome procedures, and greater patient and provider "empowerment" to increase comfort with testing protocols; (3) facility-level delays, deriving from overworked facilities and sample tracking difficulties, were highlighted as areas for improvement.
Conclusions: DRM testing has the potential to considerably improve patient health outcomes. Key informants recognized several obstacles to implementation and desired a more simplified, time-efficient, and potentially decentralized DRM testing process that builds provider comfort and confidence with DRM testing protocols. Further investigating the implementation, endurance, and effectiveness of DRM testing training is critical to addressing the barriers and areas of improvement highlighted in our study.
Trial Registration: NCT03820323.
(© 2023. BioMed Central Ltd., part of Springer Nature.)
Databáze: MEDLINE
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