Exploring How Substance Use Impedes Engagement along the HIV Care Continuum: A Qualitative Study.
Exploring How Substance Use Impedes Engagement along the HIV Care Continuum: A Qualitative Study.
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DOI：
10.3389/fpubh.2016.00062
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发表时间：
2016
影响因子：
5.2
通讯作者：
Honig S
中科院分区：
文献类型：
--
作者：
Gwadz M;de Guzman R;Freeman R;Kutnick A;Silverman E;Leonard NR;Ritchie AS;Muñoz-Plaza C;Salomon N;Wolfe H;Hilliard C;Cleland CM;Honig S
吸毒与艾滋病毒抗逆转录病毒疗法（ART）的低吸收率有关，ART是艾滋病毒护理连续体中研究不足的一步，并且对艾滋病毒初级护理的参与不足。然而，人们对药物使用阻碍这些艾滋病毒健康结果的具体潜在机制知之甚少。目前的定性研究解决了文献中的这一差距，重点是非洲裔美国人/黑人和西班牙裔艾滋病毒感染者（PLWH）谁推迟，下降，或停止ART，谁也普遍从事医疗保健差。参与者（N = 37）从一项更大的研究中有目的地抽样，以获得HIV指数的最大变化。在多层次社会认知理论的指导下，他们进行了1-2小时的音频记录的艾滋病史的深入半结构化访谈。成绩单进行了分析，使用系统的内容分析方法。与现有文献一致，大量使用药物，而不是随意或社交使用，阻碍了ART的吸收，主要是通过破坏对药物管理能力的信心和引发抑郁症。非洲裔美国人/黑人或西班牙裔种族/民族，贫困和药物使用的汇合与高水平的感知耻辱和低劣的治疗，在医疗机构相比，他们的同龄人。此外，供应商被描述为经常假设参与者出售他们的药物来购买药物，这使供应商与患者的关系紧张。在这一人群中普遍存在的对医疗的高度不信任，造成了对抗逆转录病毒疗法的恐惧，以及对街头毒品和抗逆转录病毒疗法之间的负面相互作用的恐惧，但参与者不能轻易地与卫生保健提供者讨论这一问题。抗逆转录病毒疗法启动和艾滋病毒护理的障碍存在于其他结构性和社会层面的挑战中，这些挑战不成比例地影响低收入的非洲裔美国人/黑人和西班牙裔艾滋病毒携带者（例如，无家可归、暴力）。然而，艾滋病毒管理是周期性的。在与值得信赖的供应商和辅助工作人员合作，参与者通常减少药物的使用，并启动或重新启动ART。本研究强调了一些可解决的障碍，ART启动和参与艾滋病毒护理这一弱势群体，以及在目前的做法和潜在的接口干预工作的差距。
Drug use is associated with low uptake of HIV antiretroviral therapy (ART), an under-studied step in the HIV care continuum, and insufficient engagement in HIV primary care. However, the specific underlying mechanisms by which drug use impedes these HIV health outcomes are poorly understood. The present qualitative study addresses this gap in the literature, focusing on African-American/Black and Hispanic persons living with HIV (PLWH) who had delayed, declined, or discontinued ART and who also were generally poorly engaged in health care. Participants (N = 37) were purposively sampled from a larger study for maximum variation on HIV indices. They engaged in 1–2 h audio-recorded in-depth semi-structured interviews on HIV histories guided by a multilevel social-cognitive theory. Transcripts were analyzed using a systematic content analysis approach. Consistent with the existing literature, heavy substance use, but not casual or social use, impeded ART uptake, mainly by undermining confidence in medication management abilities and triggering depression. The confluence of African-American/Black or Hispanic race/ethnicity, poverty, and drug use was associated with high levels of perceived stigma and inferior treatment in health-care settings compared to their peers. Furthermore, providers were described as frequently assuming participants were selling their medications to buy drugs, which strained provider–patient relationships. High levels of medical distrust, common in this population, created fears of ART and of negative interactions between street drugs and ART, but participants could not easily discuss this concern with health-care providers. Barriers to ART initiation and HIV care were embedded in other structural- and social-level challenges, which disproportionately affect low-income African-American/Black and Hispanic PLWH (e.g., homelessness, violence). Yet, HIV management was cyclical. In collaboration with trusted providers and ancillary staff, participants commonly reduced substance use and initiated or reinitiated ART. The present study highlights a number of addressable barriers to ART initiation and engagement in HIV care for this vulnerable population, as well as gaps in current practice and potential junctures for intervention efforts.