Understanding Specific Contexts of Antiretroviral Therapy Adherence in Rural South Africa: A Thematic Analysis of Digital Stories from a Community with High HIV Prevalence.
Understanding Specific Contexts of Antiretroviral Therapy Adherence in Rural South Africa: A Thematic Analysis of Digital Stories from a Community with High HIV Prevalence.
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DOI：
10.1371/journal.pone.0148801
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Seeley J
中科院分区：
文献类型：
--
作者：
Treffry-Goatley A;Lessells R;Sykes P;Bärnighausen T;de Oliveira T;Moletsane R;Seeley J
要实现尽可能好的预防和治疗结果，就需要近乎完美地坚持抗逆转录病毒疗法。然而，人们特别关注撒哈拉以南非洲资源有限环境中患者的依从性挑战。本研究的主要目的是探讨坚持在一个低资源，农村社区的艾滋病毒感染率高，在南非，并确定具体的个人和结构性因素，可以挑战或支持在这种情况下坚持。我们应用数字故事作为定性研究工具，以深入了解艾滋病毒和ART依从性的个人背景。通过对20个故事文本、配乐和图画的归纳性主题分析，我们探讨了参与者的经验、理解和背景，并确定了终身治疗的潜在障碍和促进因素。我们发现，许多故事反映了对ART有效性的信心日益增强，这应该被视为成功坚持的关键促进因素，因为这种态度可以促进披露并增加获得社会支持的机会。尽管如此，这些报道也突出了个人和家庭在这种情况下应对艾滋病毒和抗逆转录病毒疗法时所面临的问题的复杂性，显然，负担过重的当地卫生保健系统往往难以满足迅速蔓延的流行病的需求，并提供必要的医疗和情感支持。我们的分析表明，进一步研究和设计新的健康干预措施，以支持最佳的依从性的几个机会。首先，未来的健康促进活动应鼓励个人一起进行检测，或至少相互陪同进行检测，从一开始就鼓励社会支持。此外，可以建议进行家庭检测和ART俱乐部干预，使个人更容易坚持治疗方案，并提供支持和团结感。
Near-perfect adherence to antiretroviral therapy (ART) is required to achieve the best possible prevention and treatment outcomes. Yet, there have been particular concerns about the challenges of adherence among patients living in resource-limited settings in sub-Saharan Africa. The primary objective of this study was to explore adherence in a low-resourced, rural community of high HIV prevalence in South Africa and to identify specific individual and structural factors that can either challenge or support adherence in this context. We applied digital stories as a qualitative research tool to gain insights into personal contexts of HIV and ART adherence. Through an inductive thematic analysis of twenty story texts, soundtracks and drawings, we explored experiences, understandings, and contexts of the participants and identified potential barriers and facilitators for those on lifelong treatment. We found that many of the stories reflected a growing confidence in the effectiveness of ART, which should be viewed as a key facilitator to successful adherence since this attitude can promote disclosure and boost access to social support. Nevertheless, stories also highlighted the complexity of the issues that individuals and households face as they deal with HIV and ART in this setting and it is clear that an overburdened local healthcare system has often struggled to meet the demands of a rapidly expanding epidemic and to provide the necessary medical and emotional support. Our analysis suggests several opportunities for further research and the design of novel health interventions to support optimal adherence. Firstly, future health promotion campaigns should encourage individuals to test together, or at least accompany each other for testing, to encourage social support from the outset. Additionally, home-based testing and ART club interventions might be recommended to make it easier for individuals to adhere to their treatment regimens and to provide a sense of support and solidarity.