Successful adherence after multiple HIV treatment failures
Successful adherence after multiple HIV treatment failures
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DOI：
10.1046/j.1365-2648.2003.02928.x
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发表时间：
2004-02-01
影响因子：
3.8
通讯作者：
McKinsey, DS
中科院分区：
文献类型：
--
作者：
Enriquez, M;Lackey, NR;McKinsey, DS
背景。不坚持使用人类免疫缺陷病毒（HIV）药物通常会导致不可挽回的耐药性和不良结果。因此，护理人员普遍认为艾滋病毒疾病的治疗应推迟到患者“准备好”坚持治疗为止。然而，很少有研究关注于了解为成功遵守做好准备的过程。目标。这项现象学研究的目的是描述和理解那些在之前因不依从而治疗失败后开始坚持艾滋病毒药物治疗方案的人的经历和决策过程。采用胡塞尔现象学方法，并使用乔吉的现象学描述和分析方法进行深入访谈。调查结果。特意从美国中西部地区的两家传染病诊所中挑选了 13 名艾滋病毒呈阳性的男性和女性，他们之前因不遵守治疗方案而两次或以上治疗方案失败。他们在没有正式干预的情况下实现并持续坚持使用艾滋病药物一年或更长时间。所有参与者在该过程之前都经历了一次“触发”事件，从而能够将成功坚持所需的生活方式和健康行为改变纳入其中。与导致依从性的过程相关的因素是：改变对艾滋病毒药物治疗的态度，找到合适的医疗保健提供者，建立正确的支持系统，控制生活并制定目标。结论。这项研究表明，那些一直不坚持治疗并被视为“难以治疗”的艾滋病毒阳性个体，一旦“准备好”，就会成功地坚持治疗。这项研究的结果表明，做好准备可能是成功坚持治疗的必要组成部分，特别是对于以前治疗失败的艾滋病毒阳性个体。了解准备现象与随后的艾滋病毒治疗依从性之间的关系对于临床决策和制定增强依从性和预防艾滋病毒耐药性的干预措施具有重要意义。
Background. Non-adherence to human immunodeficiency virus (HIV) medications often results in irreparable drug resistance and poor outcomes. Hence, care providers generally think that treatment of HIV disease should be delayed until a person is 'ready' to adhere. However, little research has focused on understanding the process that results in readiness for successful adherence.Aim. The aim of this phenomenological study was to describe and understand the experience and decision-making processes of people who became adherent to their HIV medication regimens after previously failing treatment because of non-adherence.Method. A Husserlian phenomenological approach was taken, and in-depth interviews were analysed using Giorgi's method of phenomenological description and analysis.Findings. Thirteen HIV-positive men and women who had previously failed two or more treatment regimens because of non-adherence were purposefully selected from two infectious diseases clinics in the Midwest region of the United States. They had achieved and sustained adherence to their HIV medications for 1 year or longer without formal intervention. All participants experienced a 'trigger' event preceding the process that led to the ability to incorporate lifestyle and health behaviour changes necessary for successful adherence. Factors associated with the process leading to adherence were: changing attitudes towards HIV medication, finding the right health care provider, creating the right support system, getting control of life and having goals.Conclusions. This study demonstrated that HIV-positive individuals who had been non-adherent and had been viewed as 'difficult to treat' nonetheless successfully adhered to treatment once they became 'ready'. Findings from this study implicate that readiness may be a necessary component for successful adherence, particularly in HIV-positive individuals who have previously failed treatment. Understanding the relationship between the phenomenon of readiness and subsequent HIV treatment adherence has implications for clinical decision-making and for development of interventions that enhance adherence and prevent HIV drug resistance.