Challenges with pediatric antiretroviral therapy administration: Qualitative perspectives from caregivers and HIV providers in Kenya.
Challenges with pediatric antiretroviral therapy administration: Qualitative perspectives from caregivers and HIV providers in Kenya.
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DOI：
10.1371/journal.pone.0296713
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发表时间：
2024
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
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作者：
目前针对艾滋病毒儿童的儿科抗逆转录病毒疗法 (ART) 的配方对依从性存在重大障碍，导致耐药性、ART 无效以及可预防的儿童发病率和死亡率。了解这些挑战以及它们如何导致次佳依从性是改善结果的重要一步。这项定性研究描述了与养生法相关的挑战如何对依从性造成障碍并影响家庭。我们对肯尼亚锡亚亚和蒙巴萨的三所公立医院的 30 名医疗保健提供者进行了关键知情人访谈 (KII)，并与总共 72 名护理人员进行了 9 次焦点小组讨论 (FGD)。 KII 和 FGD 均经过录音、翻译和逐字转录。文字记录是根据新出现的和先验的主题手工编码的。护理人员讨论了与治疗方案相关的主要依从性挑战，包括当前配方的适口性差、复杂的制备和给药（包括测量、粉碎、溶解、混合）、复杂的药物储存和频繁的补充预约，以及这些与治疗方案相关的挑战如何导致个人和个人的依从性障碍。护理人员讨论了不良品味如何导致儿童焦虑、拒绝服药，以及护理人员在给药过程中需要使用贿赂或威胁。复杂的准备工作导致了对维护隐私和保密性的担忧和挑战，尤其是在旅行期间。提供者证实了这一患者的经历，并描述了这些给药挑战如何导致婴儿结局不佳，包括高病毒载量和可预防的发病率。医疗服务提供者讨论了补充频率如何从每两周一次到每三个月一次，具体取决于患者。护理人员讨论了这些补充频率如何打乱工作和学校日程、冒着向同伴透露不必要信息的风险、需要使用财务资源进行旅行以及最终对遵守规定构成挑战。这些发现强调需要改进儿科 ART 配方，以减轻护理人员和儿童的日常负担，从而提高依从性、改善儿童健康和家庭的整体生活质量。
Current formulations of pediatric antiretroviral therapy (ART) for children with HIV present significant barriers to adherence, leading to drug resistance, ART ineffectiveness, and preventable child morbidity and mortality. Understanding these challenges and how they contribute to suboptimal adherence is an important step in improving outcomes. This qualitative study describes how regimen-related challenges create barriers to adherence and impact families. We conducted key informant interviews (KIIs) with 30 healthcare providers and 9 focus group discussions (FGDs) with a total of 72 caregivers, across three public hospitals in Siaya and Mombasa Kenya. The KIIs and FGDs were audio recorded, translated, and transcribed verbatim. The transcripts were hand coded based on emergent and a-priori themes. Caregivers discussed major regimen-related challenges to adherence included poor palatability of current formulations, complex preparation, and administration (including measuring, crushing, dissolving, mixing), complex drug storage, and frequent refill appointments and how these regimen-related challenges contributed to individual and intrapersonal barriers to adherence. Caregivers discussed how poor taste led to child anxiety, refusal of medications, and the need for caregivers to use bribes or threats during administration. Complex preparation led to concerns and challenges about maintaining privacy and confidentiality, especially during times of travel. Providers corroborated this patient experience and described how these challenges with administration led to poor infant outcomes, including high viral load and preventable morbidity. Providers discussed how the frequency of refills could range from every 2 weeks to every 3 months, depending on the patient. Caregivers discussed how these refill frequencies interrupted work and school schedules, risked unwanted disclosure to peers, required use of financial resources for travel, and ultimately were a challenge to adherence. These findings highlight the need for improved formulations for pediatric ART to ease the daily burden on caregivers and children to increase adherence, improve child health, and overall quality of life of families.
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DOI：
10.1097/qad.0000000000001273
发表时间：
2017-01-02
期刊：
AIDS (London, England)
影响因子：
--
作者：
Muri L;Gamell A;Ntamatungiro AJ;Glass TR;Luwanda LB;Battegay M;Furrer H;Hatz C;Tanner M;Felger I;Klimkait T;Letang E;KIULARCO Study Group
通讯作者：
KIULARCO Study Group
影响因子：
3.6
作者：
Ndongo, Francis Ateba;Texier, Gaetan;Warszawski, Josiane
通讯作者：
Warszawski, Josiane
DOI：
10.1097/qai.0000000000000135
发表时间：
2014-06-01
影响因子：
3.6
作者：
Musiime, Victor;Fillekes, Quirine;Gibb, Diana M.
通讯作者：
Gibb, Diana M.
影响因子：
11.8
作者：
Abrams，Elaine J.;Capparelli，Edmund;Mirochnick，Mark
通讯作者：
Mirochnick，Mark
影响因子：
3.7
作者：
Ngarina, Matilda;Tarimo, Edith A. M.;Ekstrom, Anna Mia
通讯作者：
Ekstrom, Anna Mia