Exploring the dynamics of ART adherence in the context of a mindfulness instruction intervention among youth living with HIV in Baltimore, Maryland
Exploring the dynamics of ART adherence in the context of a mindfulness instruction intervention among youth living with HIV in Baltimore, Maryland
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DOI：
10.1080/09540121.2018.1492699
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发表时间：
2018-01-01
影响因子：
1.7
通讯作者：
Sibinga, Erica
中科院分区：
文献类型：
--
作者：
Kerrigan, Deanna;Grieb, Suzanne M.;Sibinga, Erica
感染艾滋病毒的青年坚持抗逆转录病毒疗法的比例不理想。正念指导干预措施已显示出改善药物依从性的希望，但这些干预措施的效果和机制仍在包括青年在内的艾滋病毒感染者中探索。在一项关于正念减压（MBSR）计划对艾滋病病毒感染青年的ART依从性和病毒抑制的有效性的随机对照试验中，我们对20名研究参与者（13-24岁）进行了44次迭代，半结构化，深入访谈，这些参与者是从马里兰州巴尔的摩的两个学术中心的诊所招募的。访谈探讨了社会背景和心理社会动力学的ART坚持的背景下，MBSR干预，与那些在控制arm. We采用主题内容分析系统编码和合成文本访谈数据。参与者在坚持抗逆转录病毒治疗方面面临的挑战往往是在一个持续的过程中，除了其他交叉的社会耻辱、不平等和压力因素外，还将艾滋病毒作为一种耻辱化的慢性疾病进行管理。参与正念减压疗法项目和相关的团体支持，使参与者能够不加评判地观察和接受与艾滋病毒感染者和接受抗逆转录病毒治疗相关的困难想法、感受和经历，这促进了更多的报告依从性。正念训练可以激发新的观点和理解，包括感染艾滋病毒的年轻人更好地接受自我和疾病，从而改善艾滋病毒的结果。
Youth living with HIV have sub-optimal rates of adherence to antiretroviral therapy (ART). Mindfulness instruction interventions have shown promise for improving medication adherence, but the effects and mechanisms of these interventions are still being explored among people living with HIV, including youth. In the context of a randomized controlled trial of the efficacy of a Mindfulness-Based Stress Reduction (MBSR) program on ART adherence and viral suppression among youth living with HIV, we conducted 44 iterative, semi-structured, in-depth interviews with 20 study participants (13-24 years) recruited from clinics at two academic centers in Baltimore, Maryland. Interviews explored the social context and psychosocial dynamics of ART adherence in the context of the MBSR intervention, compared with those in a control arm. We employed thematic content analysis to systematically code and synthesize textual interview data. Participants' challenges with ART adherence were often situated within an ongoing process of working to manage HIV as a stigmatized, chronic condition in addition to other intersecting social stigmas, inequalities, and stressors. Participation in the MBSR program and related group support allowed participants to non-judgmentally observe and accept difficult thoughts, feelings, and experiences associated with living with HIV and taking ART, which facilitated greater reported adherence. Mindfulness training may stimulate new perspectives and understanding, including greater self- and illness-acceptance among youth living with HIV, leading to improved HIV outcomes.