Factors facilitating and challenging access and adherence to antiretroviral therapy in a township in the Zambian Copperbelt: a qualitative study
Factors facilitating and challenging access and adherence to antiretroviral therapy in a township in the Zambian Copperbelt: a qualitative study
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DOI：
10.1080/09540120701854634
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发表时间：
2008-01-01
影响因子：
1.7
通讯作者：
Murray, Scott A.
中科院分区：
文献类型：
--
作者：
Grant, Elizabeth;Logie, Dorothy;Murray, Scott A.
抗逆转录病毒治疗在非洲社区越来越普及。我们着手获得患者对促进和挑战获得和坚持这种治疗的因素的看法。我们对来自赞比亚铜带三个经济贫困乡镇的40名艾滋病毒阳性患者进行了两次半结构化访谈，访谈间隔12个月。我们还对这些受访者中的12人进行了焦点小组讨论。保健设施的药品供应并不能自动确保有需要者获得药品。开始治疗的先决条件是艾滋病毒检测结果呈阳性记录，但艾滋病毒检测中心太少，害怕家庭和社区拒绝以及男性在性和社会决策方面的主导地位，使许多人不敢前来接受检测。一旦进入保健系统，诸如不良副作用的谣言、不一致的信息、高昂的药物费用（在第一次面谈时）、额外医疗检查的持续费用、系统过度拥挤和工作人员过度劳累等进一步的障碍都阻碍了获得治疗。服用后，治疗会带来副作用，最常见的是食欲和饥饿感增加。然而，尽管存在这些障碍和挑战，许多接受治疗的患者报告了良好的依从性。即时因素，例如看到病人康复；由朋友或家人支持的；有一个手表或时钟来保持规律的作息是很重要的。预计将死亡但现在看起来健康的人数增加也改变了社区的态度。艾滋病毒/艾滋病正开始从一种隐蔽的绝症转变为一种可治疗的慢性疾病。
Antiretroviral therapy is increasingly available in African communities. We set out to gain patient perceptions on factors that facilitate and challenge access and adherence to such therapy. We carried out two semi-structured interviews 12 months apart with 40 HIV-positive people drawn from three economically deprived townships in the Copperbelt, Zambia. We also conducted a focus group of 12 of these interviewees. Availability of medication in health facilities did not automatically ensure access to those in need. A prerequisite for commencing on treatment was a positive documented HIV test result, but too few HIV testing centres, fear of family and community rejection and male domination in sexual and social decision-making prevented a number from coming forward to be tested. Once within the system of care, further barriers, such as rumours of bad side-effects, inconsistent information, high costs of drugs (at the time of the first interviews), ongoing costs of additional medical tests, overcrowded systems and overworked staff, all hindered access to receiving treatment. When taken, therapy brought side-effects, the most common being increased appetite and hunger. Yet, despite these barriers and challenges many of those on treatment reported good adherence. Immediate factors, such as seeing ill people becoming well; being supported by a friend or family member; and having a watch or clock to keep to a regular regime, were important. The increase in the number of people who were expected to die but were now looking well also shifted community attitudes. HIV/AIDS is beginning to move from a hidden terminal disease to a chronic condition that is treatable.