Barriers and facilitators to chemotherapy initiation and adherence for patients with HIV-associated Kaposi's sarcoma in Kenya: a qualitative study.
Barriers and facilitators to chemotherapy initiation and adherence for patients with HIV-associated Kaposi's sarcoma in Kenya: a qualitative study.
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DOI：
10.1186/s13027-022-00444-0
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发表时间：
2022-07-06
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
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卡波西肉瘤是撒哈拉以南非洲地区最常见的艾滋病毒相关恶性肿瘤之一，通常在疾病晚期才被诊断出来。只有50%有资格接受化疗的KS患者接受了化疗，而且依从性不是最佳的。在肯尼亚西部的AMPATH诊所网络中，有目的地选择57名18岁的新诊断为KS的患者参加半结构化访谈，根据他们是否已经完成、部分完成或未完成晚期KS的化疗进行分层。访谈指南和编码框架基于情境信息、动机、行为技能（sIMB）框架，其中以患者为中心的核心IMB结构被置于接受护理的社会生态背景中。在57名参与者中，年龄中位数为37岁（IQR 32-41），大多数是男性（68%）。化疗开始和坚持的显著障碍包括缺乏经济手段，预约困难，如距离设施的距离，预约时间，排长队，预约有限，个人障碍，如恐惧或绝望，以及缺乏适当或足够的化疗信息。促进化疗开始和坚持的因素包括健康素养、治疗症状的动机、化疗的改善、自我护理的优先顺序、经历副作用时的复原力、执行行为技能的能力、获得国家健康保险和免费化疗。我们关于肯尼亚西部KS化疗开始和坚持的障碍和促进因素的研究结果支持进一步的工作，以可靠的癌症和化疗信息促进公共卫生运动，改善化疗过程和副作用的教育，提高肿瘤服务能力，支持国民健康保险的登记，并增加将慢性病护理纳入现有的艾滋病毒治疗网络。
Kaposi sarcoma is one of the most prevalent HIV-associated malignancies in sub-Saharan Africa and is often diagnosed at advanced stage of disease. Only 50% of KS patients who qualify for chemotherapy receive it and adherence is sub-optimal. 57 patients > 18 years with newly diagnosed KS within the AMPATH clinic network in Western Kenya were purposively selected to participate in semi-structured interviews stratified by whether they had completed, partially completed, or not completed chemotherapy for advanced stage KS. We based the interview guide and coding framework on the situated Information, Motivation, Behavioral Skills (sIMB) framework, in which the core patient centered IMB constructs are situated into the socioecological context of receiving care. Of the 57 participants, the median age was 37 (IQR 32–41) and the majority were male (68%). Notable barriers to chemotherapy initiation and adherence included lack of financial means, difficulty with convenience of appointments such as distance to facility, appointment times, long lines, limited appointments, intrapersonal barriers such as fear or hopelessness, and lack of proper or sufficient information about chemotherapy. Factors that facilitated chemotherapy initiation and adherence included health literacy, motivation to treat symptoms, improvement on chemotherapy, prioritization of self-care, resilience while experiencing side effects, ability to carry out behavioral skills, obtaining national health insurance, and free chemotherapy. Our findings about the barriers and facilitators to chemotherapy initiation and adherence for KS in Western Kenya support further work that promotes public health campaigns with reliable cancer and chemotherapy information, improves education about the chemotherapy process and side effects, increases oncology service ability, supports enrollment in national health insurance, and increases incorporation of chronic disease care into existing HIV treatment networks.
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DOI：
10.1097/qai.0000000000002699
发表时间：
2021-08-15
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Freeman EE;Semeere A;McMahon DE;Byakwaga H;Laker-Oketta M;Regan S;Wenger M;Kasozi C;Ssemakadde M;Bwana M;Kanyesigye M;Kadama-Makanga P;Rotich E;Kisuya J;Wools-Kaloustian K;Bassett IV;Busakhala N;Martin J
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Martin J
影响因子：
3.4
作者：
Krown SE
通讯作者：
Krown SE
影响因子：
4.5
作者：
Burt LM;McCormak M;Lecuru F;Kanyike DM;Bvochora-Nsingo M;Ndlovu N;Scott AA;Anorlu RI;Sharma V;Plante M;Nyongesa C;Tigeneh W;Fakie N;Suneja G;Gaffney DK
通讯作者：
Gaffney DK
影响因子：
4
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Semeere A;Wenger M;Busakhala N;Buziba N;Bwana M;Muyindike W;Amerson E;Maurer T;McCalmont T;LeBoit P;Musick B;Yiannoutsos C;Lukande R;Castelnuovo B;Laker-Oketta M;Kambugu A;Glidden D;Wools-Kaloustian K;Martin J
通讯作者：
Martin J
DOI：
10.1097/qai.0b013e318251aedd
发表时间：
2012-06-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Mosam A;Shaik F;Uldrick TS;Esterhuizen T;Friedland GH;Scadden DT;Aboobaker J;Coovadia HM
通讯作者：
Coovadia HM