Facilitators and barriers to medication adherence in an HIV prevention study among men who have sex with men in the iPrEx study in Chiang Mai, Thailand
Facilitators and barriers to medication adherence in an HIV prevention study among men who have sex with men in the iPrEx study in Chiang Mai, Thailand
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DOI：
10.1080/09540121.2012.748871
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发表时间：
2013-08-01
影响因子：
1.7
通讯作者：
Grant, Robert
中科院分区：
文献类型：
--
作者：
Tangmunkongvorakul, Arunrat;Chariyalertsak, Suwat;Grant, Robert
2008年，暴露前预防倡议(Iprex)研究扩大到泰国清迈的男男性行为者(MSM)。总之，来自清迈的114名参与者参加了这项国际双盲试验，每日服用FTC-TDF(Truvada(R))或安慰剂作为暴露前预防(PrEP)艾滋病毒预防策略。为了更好地了解Iprex参与者的特征，特别是来自泰国这一服务不足的人群，并了解他们作为这项盲目PrEP试验的一部分尝试每天服用片剂的经历，我们进行了一项定性研究。2010年，32名MSM Iprex参与者进行了深入访谈，另有14人参加了焦点小组讨论。定性分析的结果表明，参与者对Iprex研究和研究药物的总体态度是积极的，这与坚持每天服用药物的比率很高有关。参与者还反映，作为参与试验的一部分，提供高质量的医疗保健，以及临床研究人员、家人和朋友的支持，有助于支持较高的研究用药依从率。关于坚持的挑战的讨论包括服药行为，这是与生活方式、生活安排、社交生活联系在一起的，被错误地确定为艾滋病毒阳性或无意向家人和朋友透露性身份的社会耻辱，以及与伴侣的关系冲突。研究结果提供了在MSM社区、密切关系和研究氛围的更大背景下研究药物和日常依从性的参与者体验的更广泛的视角，并可用于在这些社区内构建PrEP依从性支持方法。
In 2008, the Pre-exposure Prophylaxis Initiative (iPrEx) study expanded to include men who have sex with men (MSM) in Chiang Mai, Thailand. In full, 114 participants from Chiang Mai joined this international double-blinded trial of daily FTC-TDF (Truvada (R)) or placebo as a pre-exposure prophylaxis (PrEP) HIV prevention strategy. To better understand the characteristics of iPrEx participants specifically from this underserved population in Thailand, and gain insights into their experiences of trying to take a daily tablet as part of this blinded PrEP trial, we conducted a qualitative study. In 2010, 32 MSM iPrEx participants provided in-depth interviews and an additional 14 joined focus group discussions. Results of the qualitative analyzes suggested that participants held generally positive attitudes toward the iPrEx study and study medication and related this to high rates of adherence to the daily regimen. Participants also reflected on the provision of quality health care as part of participation in the trial, as well as support from clinical research staff, family and friends as helpful in supporting high rates of study medication adherence. Discourse concerning challenges to adherence included medication taking behavior, which was contextualized by lifestyle, living arrangement, social life, social stigma in terms of being mistakenly identified as HIV positive or unintentional disclosure of sexual identity to family and friends, and relationship conflicts with partners. The results provide broader perspectives of participant experiences of the study medication and daily adherence in the larger contexts of the MSM community, close relationships, and the study climate, and can be leveraged in constructing PrEP adherence support approaches within these communities.