The Role of Self-Efficacy in HIV treatment Adherence and its interaction with psychosocial factors among HIV Positive Adolescents in Transition to Adult Care in Kenya.
The Role of Self-Efficacy in HIV treatment Adherence and its interaction with psychosocial factors among HIV Positive Adolescents in Transition to Adult Care in Kenya.
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DOI：
10.1080/17450128.2021.1954736
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发表时间：
2022
影响因子：
1.1
通讯作者：
Memiah, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Gitahi, Nyawira;Wahome, Samuel;Bukusi, Peter;Memiah, Elizabeth A.
青少年和年轻人（15-24岁）HIV临床结果比成人差。尽管如此，关于撒哈拉以南非洲感染艾滋病毒的围产期青少年坚持抗逆转录病毒治疗的自我效能等个人因素的数据很少。我们的研究探讨了在肯尼亚内罗毕接受治疗的青少年中抗逆转录病毒治疗依从性、自我效能感和其他心理社会因素之间的相互作用。我们招募了16-19岁的围产期感染艾滋病毒的青少年（ALWHIV），他们在艾滋病毒诊所接受常规护理。我们测量了自我报告的ART依从性（7天回忆），并将最佳依从性定义为> 95%，并进行了回归分析以确定独立相关因素。中介分析探讨了社会心理变量之间的相互作用。我们招募了82名中位年龄为17岁（IQR 16，18）的ALWHIV患者，他们接受ART治疗的中位年龄为11岁（IQR 7，13）。64%（52）的ALWHIV报告最佳依从性> 95%，15%报告缺失剂量三个月或更长时间。在控制了其他协变量后，自尊、高病毒载量和依从性水平> 95%与依从性自我效能显著相关。自尊与依从性、自我效能感和社会支持显著相关（分别为p<0.001和p=0.001）。参数化检验表明，自我效能与依从性之间的关系是由自尊介导的，总效应OR为6.93（bootstrap 95%CI为1.99-24.14）。自尊在依从行为发展中起中介作用。侧重于提高艾滋病毒/艾滋病患者遵守率的干预措施应包括建立自尊的内容。
Adolescents and young adults (15–24 yrs.) have poorer HIV clinical outcomes than adults. Despite this, there is minimal data on individual-level factors such as self-efficacy towards antiretroviral adherence among perinatally infected adolescents living with HIV in sub-Saharan Africa. Our study examined the interaction between antiretroviral treatment adherence self-efficacy and other psychosocial factors among adolescents receiving care in Nairobi, Kenya. We enrolled perinatally infected Adolescent Living with HIV (ALWHIV) 16–19 yrs. who were accessing care routinely at the HIV clinic. We measured self-reported ART adherence (7-day recall) and defined optimal adherence as >95%, and conducted a regression analysis to identify independently associated factors. Mediation analysis explored interactions between the psychosocial variables. We enrolled 82 ALWHIV median age 17 (IQR 16,18) who had been on ART for a median age of 11 yrs. (IQR 7,13). Sixty-four per cent (52) of the ALWHIV reported optimal adherence of >95%, and 15% reported missing doses for three or more months. After controlling for the other covariates, self-esteem, high viral load and an adherence level > 95% were significantly associated with adherence self-efficacy. Self-esteem was significantly associated with adherence self-efficacy and social support (p<0.001 and p=0.001), respectively. The paramed test indicated that the association between self-efficacy and adherence was mediated by self-esteem with a total effect of OR 6.93 (bootstrap 95% CI 1.99–24.14). Adherence self-efficacy was also mediated by self-esteem in developing adherence behavior. Interventions focused on increasing adherence among ALWHIV should include self-esteem building components.
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