Voices on adherence to ART in Ethiopia and Uganda: a matter of choice or simply not an option?
Voices on adherence to ART in Ethiopia and Uganda: a matter of choice or simply not an option?
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DOI：
10.1080/09540120902883119
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发表时间：
2009-01-01
影响因子：
1.7
通讯作者：
Fochsen, Grethe
中科院分区：
文献类型：
--
作者：
Gusdal, Annelie K.;Obua, Celestino;Fochsen, Grethe
本文探讨艾滋病毒患者坚持抗逆转录病毒治疗（ART）在资源有限的情况下，在乌干达和埃塞俄比亚，ART是免费提供的。定性半结构化访谈进行了79例患者，17名同伴辅导员，和22个供应商在城市和农村地区的埃塞俄比亚和乌干达的ART设施。受访者从个人和系统层面表达了他们对坚持抗逆转录病毒疗法的经验和看法。内容分析中出现了两个主题：“患者的竞争成本和系统的资源限制”和“患者对ART的信任和患者-提供者接触的质量”。第一个主题是指患者的依从性如何受到以下困难的挑战：支持自己和家人，支付交通费用，药物补充和后续行动以及支付登记费，机会性感染治疗和昂贵的转诊到其他医院。第二个主题描述了影响患者坚持能力的因素：治疗中的个人责任，对抗逆转录病毒药物效果的信任，以及对咨询质量的信任。为了使患者有一个公平的选择，以成功地坚持抗逆转录病毒疗法，交通费用的抗逆转录病毒疗法设施需要减少。这意味着为病人提供更长时间的药物，并安排更好的实验室服务，从而不必经常复诊。服务应该更接近患者和用于药品分配的外围社区卫生工作者。有必要培训提供者和同伴辅导员，在沟通技巧和坚持辅导。
This paper explores HIV patients' adherence to antiretroviral treatment (ART) in resource-limited contexts in Uganda and Ethiopia, where ART is provided free of charge. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Interviewees voiced their experiences of, and views on ART adherence both from an individual and a system level perspective. Two main themes emerged from the content analysis: "Patients' competing costs and systems' resource constraints'' and "Patients' trust in ART and quality of the patient-provider encounters.'' The first theme refers to how patients' adherence was challenged by difficulties in supporting themselves and their families, paying for transportation, for drug refill and follow-up as well as paying for registration fees, opportunistic infection treatment, and expensive referrals to other hospitals. The second theme describes factors that influenced patients' capacity to adhere: personal responsibility in treatment, trust in the effects of antiretroviral drugs, and trust in the quality of counseling. To grant patients a fair choice to successfully adhere to ART, transport costs to ART facilities need to be reduced. This implies providing patients with drugs for longer periods of time and arranging for better laboratory services, thus not necessitating frequent revisits. Services ought to be brought closer to patients and peripheral, community-based healthworkers used for drug distribution. There is a need for training providers and peer counselors, in communication skills and adherence counseling.