Challenges faced by caregivers of virally non-suppressed children on the intensive adherence counselling program in Uganda: a qualitative study
Challenges faced by caregivers of virally non-suppressed children on the intensive adherence counselling program in Uganda: a qualitative study
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DOI：
10.1186/s12913-019-3963-y
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发表时间：
2019-03-07
影响因子：
2.8
通讯作者：
Nakanjako, Damalie
中科院分区：
文献类型：
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作者：
Nasuuna, Esther;Kigozi, Joanita;Nakanjako, Damalie
在乌干达估计有130，000名感染艾滋病毒的儿童中，47%正在接受抗逆转录病毒治疗。只有39.3%的儿童将HIV-1病毒载量抑制到每毫升50个拷贝以下。护理人员是坚持实现儿童病毒抑制的关键驱动力。我们调查的挑战和潜在的支持所需的照顾者的ART治疗children.MethodsA定性研究内进行了传染病研究所儿科ART计划在坎帕拉和Hoima区。病毒载量超过1000拷贝的儿童的照顾者被有目的地抽样，并参与五个焦点小组讨论（FGD）。FGD指南强调了照顾者面临的挑战以及他们需要何种支持来提高儿童抗逆转录病毒治疗依从性的问题。采用了归纳法进行专题分析。所有的成绩单阅读，编码和紧急的主题determined.ResultsOverall，37照顾者参加了五FGD，其中29（78%）是女性，28（76%）是HIV感染者和25（68%）的孩子的亲生父母。引出的挑战是未能参加咨询会议或支持坚持服药。个人和卫生系统面临的挑战，如相互竞争的优先事项、后勤、咨询质量差和缺乏提醒，阻碍了参加咨询会议。五个主题成为支持遵守的挑战：i）环境（学校活动，离家工作），ii）个人（不披露，耻辱），iii）心理（内疚），iv）财务（缺乏食物和交通）和v）与儿童有关（疲劳和同伴影响）。护理人员需要的支助有三大主题，即：（a）卫生系统改革（校外门诊预约，尽量减少抗逆转录病毒药物缺货，提高咨询质量），B）心理社会支助（支持向儿童及其家人披露艾滋病毒状况，更经常地参加同伴支助小组和育儿班）和c）增强经济权能（职业技能培训、学费支持和开展创收活动的机会）.Discussion and conclusionTo achieve viral suppression，ART programs require targeted efforts to provide specific health facility requirements，心理和经济需求的ART治疗的儿童和他们的照顾者。将艾滋病毒治疗与孤儿和弱势儿童计划相结合可能会提高病毒抑制率。
BackgroundOf the estimated 130,000 children living with HIV in Uganda, 47% are receiving ART. Only 39.3% have suppressed HIV-1 viral load to levels below 50 copies per ml. Caregivers are key drivers of adherence to achieve viral suppression in children. We investigated the challenges and potential support required by caregivers of ART-treated children.MethodsA qualitative study was conducted within the Infectious Diseases Institute paediatric ART program in Kampala and Hoima districts. Caregivers of children with viral loads above 1000 copies were purposively sampled and engaged in five focus group discussions (FGD). The FGD guide highlighted questions on challenges that caregivers face and the kind of support they required to improve children's ART adherence. Thematic analysis using the inductive approach was used. All the transcripts were read, coded and emergent themes determined.ResultsOverall, 37 caregivers participated in five FGD, of whom 29 (78%) were female, 28 (76%) were HIV-infected and 25 (68%) were biological parents of the children. The elicited challenges were either in failure to attend the counselling sessions or in supporting adherence to medication. Individual and health system challenges such as competing priorities, logistics, poor quality of counselling and lack of reminders prevented attendance at counselling sessions. Five themes emerged as challenges to supporting adherence: i) environmental (school activities, working away from home), ii) personal (non-disclosure, stigma), iii) psychological (guilt), iv) financial (lack of food and transport) and v) child-related (fatigue and peer influence). Three major themes emerged for the support that caregivers needed namely: a) health system reforms (clinic appointments outside school hours, minimize ART drug stock outs and improve quality of counselling), b)psychosocial support (support with disclosure of HIV status to children and their families, more frequent peer support groups and parenting classes) and c) economic empowerment (training in vocational skills, school fees support and opportunities to initiate income generating activities).Discussion and conclusionTo achieve viral suppression, ART programs require targeted efforts to provide specific health facility requirements, psychological and economic needs of ART-treated children and their caregivers. Integration of HIV treatment with programs for orphans and vulnerable children may improve viral suppression rates.