"How am I going to live?": exploring barriers to ART adherence among adolescents and young adults living with HIV in Uganda.
"How am I going to live?": exploring barriers to ART adherence among adolescents and young adults living with HIV in Uganda.
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DOI：
10.1186/s12889-018-6048-7
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发表时间：
2018-10-04
影响因子：
4.5
通讯作者：
Linnemayr S
中科院分区：
文献类型：
--
作者：
MacCarthy S;Saya U;Samba C;Birungi J;Okoboi S;Linnemayr S
来自撒哈拉以南非洲（SSA）的研究记录了抗逆转录病毒治疗依从性的障碍如何在感染艾滋病毒的青少年和年轻人中造成额外的并发症。我们定性地探讨了乌干达14-24岁人群坚持抗逆转录病毒治疗的障碍，以了解这一年龄组所面临的独特挑战。我们在乌干达的坎帕拉与社区咨询委员会成员（n = 1）、卫生保健提供者（n = 2）以及14-17岁青少年（n = 2）和18-24岁青年（n = 2）的男性和女性群体进行了焦点小组（FG）讨论。将FG逐字转录并从卢甘达翻译成英语。两名研究人员独立审查了所有的成绩单，开发了一个详细的密码本，实现了0.79和0.80的科恩的Kappa值，并使用定向内容分析来确定关键主题。坚持抗逆转录病毒治疗面临四个障碍：1）贫困限制了青少年购买食物的能力，削弱了他们从青春期向成年过渡期间实现经济独立的努力; 2）上学限制了他们的隐私，进一步破坏了坚持抗逆转录病毒治疗; 3）家庭支持不可靠，年轻人经常因为监护人的不断变化而挣扎，因为他们的亲生父母死于艾滋病毒。相比之下，同龄人的影响，特别是在艾滋病毒阳性的青年，是强大的，并创造了一个重要的网络，以支持抗逆转录病毒疗法的坚持; 4）每天服用多种药物的负担沮丧的青年，往往导致所谓的“药物假期”。在四个障碍中的三个障碍中，出现了青少年和青年特有的信息披露问题。为了有效，提高乌干达青年抗逆转录病毒治疗依从性的计划和政策必须解决青少年和年轻人在实现最佳依从性方面面临的特殊挑战。例如，关于预算编制和储蓄做法的培训可有助于促进他们向财务独立过渡。学校工作人员可以制定策略，帮助学生一致和保密地服药。虽然扩大艾滋病毒诊所提供的服务范围具有挑战性，但成功的努力将需要让家庭、同龄人以及更大的保健和教育提供者社区参与，以支持感染艾滋病毒的青少年和年轻人活得更长和更健康。ClinicalTrials.gov标识符：NCT 02514356。2015年8月3日注册。
Studies from sub-Saharan Africa (SSA) document how barriers to ART adherence present additional complications among adolescents and young adults living with HIV. We qualitatively explored barriers to ART adherence in Uganda among individuals age 14–24 to understand the unique challenges faced by this age group. We conducted focus group (FG) discussions with Community Advisory Board members (n = 1), health care providers (n = 2), and male and female groups of adolescents age 14–17 (n = 2) and youth age 18–24 (n = 2) in Kampala, Uganda. FGs were transcribed verbatim and translated from Luganda into English. Two investigators independently reviewed all transcripts, developed a detailed codebook, achieved a pooled Cohen’s Kappa of 0.79 and 0.80, and used a directed content analysis to identify key themes. Four barriers to ART adherence emerged: 1) poverty limited adolescents’ ability to buy food and undercut efforts to become economically independent in their transition from adolescence to adulthood; 2) school attendance limited their privacy, further disrupting ART adherence; 3) family support was unreliable, and youth often struggled with a constant change in guardianship because they had lost their biological parents to HIV. In contrast peer influence, especially among HIV-positive youth, was strong and created an important network to support ART adherence; 4) the burden of taking multiple medications daily frustrated youth, often leading to so-called ‘drug holidays.’ Adolescent and youth-specific issues around disclosure emerged across three of the four barriers. To be effective, programs and policies to improve ART adherence among youth in Uganda must address the special challenges that adolescents and young adults confront in achieving optimal adherence. For example, training on budgeting and savings practices could help promote their transition to financial independence. School staff could develop strategies to help students take their medications consistently and confidentially. While challenging to extend the range of services provided by HIV clinics, successful efforts will require engaging the family, peers, and larger community of health and educational providers to support adolescents and young adults living with HIV to live longer and healthier lives. ClinicalTrials.gov Identifier: NCT02514356. Registered August 3, 2015.
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影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
DOI：
10.1097/00042560-200205010-00014
发表时间：
2002-05-01
期刊：
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
影响因子：
--
作者：
de Olalla, PG;Knobel, H;Caylà, JA
通讯作者：
Caylà, JA
影响因子：
3.7
作者：
Bygrave H;Mtangirwa J;Ncube K;Ford N;Kranzer K;Munyaradzi D
通讯作者：
Munyaradzi D
DOI：
10.1080/09540120902883119
发表时间：
2009-01-01
影响因子：
1.7
作者：
Gusdal, Annelie K.;Obua, Celestino;Fochsen, Grethe
通讯作者：
Fochsen, Grethe
影响因子：
1.9
作者：
Frega, Romeo;Duffy, Francesca;Grede, Nils
通讯作者：
Grede, Nils