Understanding Patterns of Social Support and Their Relationship to an ART Adherence Intervention Among Adults in Rural Southwestern Uganda.
Understanding Patterns of Social Support and Their Relationship to an ART Adherence Intervention Among Adults in Rural Southwestern Uganda.
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DOI：
10.1007/s10461-016-1559-7
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发表时间：
2017-02
影响因子：
4.4
通讯作者：
Haberer JE
中科院分区：
文献类型：
--
作者：
Atukunda EC;Musiimenta A;Musinguzi N;Wyatt MA;Ashaba J;Ware NC;Haberer JE
短信是一种全球广泛使用的技术，也可能改善抗逆转录病毒治疗的依从性，然而，在最近的一项试点试验中，在实时检测漏服剂量后向社会支持者发送短信通知没有显示出明显的益处。我们研究了可能解释这一发现的人口统计学和社会文化动态。在试验中，63名开始抗逆转录病毒治疗的艾滋病毒阳性个体接受了实时依从性监测，并被随机分为两种类型的短信提醒干预和对照组（不发短信）。短信通知也被发送给45名患者确认的持续依从性缺失的社会支持者。与参与者一样，社会支持者在登记时，在他们匹配的参与者的依从期结束后和退出时接受了采访。有固定收入的社会支持者（RR = 0.27, P = 0.001）与较少的依从性缺失显著相关。工具性支持仅在食物安全的社会支持者中与较少的依从性缺失相关（RR = 0.58, P = 0.003）。定性访谈数据揭示了影响社会支持的经济和关系动态的多样性和复杂性。在情感上积极的关系中，资源的可用性似乎促进了有益的支持，而有限的资源阻碍了对许多人的积极支持。有效的社会支持似乎取决于社会支持者的粮食安全、经济稳定和依赖于信任和支持性披露的运作良好的社会网络。
SMS is a widely used technology globally and may also improve ART adherence, yet SMS notifications to social supporters following real-time detection of missed doses showed no clear benefit in a recent pilot trial. We examine the demographic and social-cultural dynamics that may explain this finding. In the trial, 63 HIV-positive individuals initiating ART received a real-time adherence monitor and were randomized to two types of SMS reminder interventions versus a control (no SMS). SMS notifications were also sent to 45 patient-identified social supporters for sustained adherence lapses. Like participants, social supporters were interviewed at enrollment, following their matched participant’s adherence lapse and at exit. Social supporters with regular income (RR = 0.27, P = 0.001) were significantly associated with fewer adherence lapses. Instrumental support was associated with fewer adherence lapses only among social supporters who were food secure (RR = 0.58, P = 0.003). Qualitative interview data revealed diverse and complex economic and relationship dynamics, affecting social support. Resource availability in emotionally positive relationships seemingly facilitated helpful support, while limited resources prevented active provision of support for many. Effective social support appeared subject to social supporters’ food security, economic stability and a well-functioning social network dependent on trust and supportive disclosure.