Cultural adaptation of a cognitive-behavioural intervention to improve adherence to antiretroviral therapy among people living with HIV/AIDS in Zimbabwe: Nzira Itsva.
Cultural adaptation of a cognitive-behavioural intervention to improve adherence to antiretroviral therapy among people living with HIV/AIDS in Zimbabwe: Nzira Itsva.
复制标题
DOI：
10.1177/1359105315626783
复制
发表时间：
2017-09
影响因子：
3.2
通讯作者：
Abas M
中科院分区：
文献类型：
--
作者：
Bere T;Nyamayaro P;Magidson JF;Chibanda D;Chingono A;Munjoma R;Macpherson K;Ndhlovu CE;O'Cleirigh C;Kidia K;Safren SA;Abas M
用于改善抗逆转录病毒治疗依从性的循证干预措施很少在非洲使用。我们在津巴布韦的哈拉雷选择、文化适应并测试了认知-行为干预的可行性，以坚持并在诊所实施。干预包括一次50分钟的解决问题的认知行为干预课程，其中包括四次基于技能的强化课程，由四名非专业人员在艾滋病毒护理方面提供。适应遵循一种理论上驱动的干预适应方法，即Assessment-Decision-Administration-Production-Topical专家-整合-培训-测试(ADAPT-ITT)，包括修改语言、课程长度、为非专业顾问提供的定制内容以及纳入具有文化能力的调查。使用混合方法评估干预的可行性，包括对提供干预的提供者的忠诚度的评级，以及使用与咨询师(n=4)和患者(n=15)的个人半结构化访谈对可行性的定性评估。当对42名患者实施干预时，该干预是可行和可接受的，并导致15名患者的自我报告依从性得到改善，这些患者在6个月后进行了随访。这项研究的下一步包括进行一项随机对照试验，在长期随访中与更大样本的护理标准进行比较，评估适应的干预措施。
Few evidence-based interventions to improve adherence to antiretroviral therapy have been adapted for use in Africa. We selected, culturally adapted and tested the feasibility of a cognitive-behavioural intervention for adherence and for delivery in a clinic setting in Harare, Zimbabwe. The intervention consisted of a single, 50-minute problem-solving cognitive-behavioural intervention session with four skill-based booster sessions, delivered by four lay adherence counsellors in the context of HIV care. Adaptation followed a theoretically driven approach to intervention adaptation, Assessment-Decision-Administration-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT), and included modifications to language, session length, tailoring content for delivery by lay counsellors and inclusion of culturally competent probes. The feasibility of the intervention was evaluated using a mixed-methods assessment, including ratings of provider fidelity of intervention delivery, and qualitative assessments of feasibility using individual semi-structured interviews with counsellors (n = 4) and patients (n = 15). The intervention was feasible and acceptable when administered to 42 patients and resulted in improved self-reported adherence in a subset of 15 patients who were followed up after 6 months. Next steps from this study include conducting a randomised control trial to evaluate the adapted intervention compared to standard of care in a larger sample over a long-term follow-up.