Barriers to and Facilitators of Adherence to Pediatric Antiretroviral Therapy in a Sub-Saharan Setting: Insights from a Qualitative Study
Barriers to and Facilitators of Adherence to Pediatric Antiretroviral Therapy in a Sub-Saharan Setting: Insights from a Qualitative Study
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DOI：
10.1089/apc.2011.0083
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发表时间：
2011-10-01
影响因子：
4.9
通讯作者：
Behets, Frieda
中科院分区：
文献类型：
--
作者：
Fetzer, Bradley C.;Mupenda, Bavon;Behets, Frieda
尽管艾滋病毒阳性儿童需要有效地坚持抗逆转录病毒治疗（ART），但在资源有限的情况下，儿科抗逆转录病毒治疗的指导理论仍然缺失。了解影响儿童抗逆转录病毒治疗依从性的因素对于制定适当的策略至关重要。在刚果民主共和国金沙萨，对20组艾滋病毒披露和未披露的儿童以及各自的护理人员进行了深入的定性访谈，以更好地表征儿童接受抗逆转录病毒治疗的障碍、促进者和坚持治疗的经历。通常提到的障碍包括缺乏食物或营养支持、缺乏对儿童的帮助或监督、缺乏对护理人员的帮助以及无法记住持续服药。促进因素包括牢固的照顾者与儿童的关系和支持系统，以及保持依从性的策略。类似的主题也出现在照顾儿童的人群中，但两者之间的特征往往不同。了解自己艾滋病毒状况的儿童在服药和照料儿童的关系中出现挫折和冲突的情况较少。对儿童抗逆转录病毒治疗依从性的持续研究应考虑到儿童和照顾者的不同观点，以及披露和未披露状况的儿童之间的差异。未来干预的领域应侧重于儿童与照料者的关系、艾滋病毒状况的披露以及为儿童及其照料者提供的营养和社会心理支持。
Despite the need for HIV-positive children to adhere effectively to antiretroviral treatment (ART), a guiding theory for pediatric ART in resource-limited settings is still missing. Understanding factors that influence pediatric ART adherence is critical to developing adequate strategies. In-depth qualitative interviews were undertaken in Kinshasa, Democratic Republic of the Congo, with 20 sets of HIV disclosed and nondisclosed children along with respective caregivers to better characterize barriers, facilitators, and adherence experiences in children taking ART. Commonly cited barriers included lack of food or nutritional support, lack of assistance or supervision for children, lack of assistance for caregivers, and being unable to remember to take medicines on a consistent basis. Facilitators included having a strong caregiver-child relationship and support system along with strategies for maintaining adherence. Similar themes arose within the child-caregiver sets, but were often characterized differently between the two. Children who were aware of their HIV status displayed fewer instances of frustration and conflict concerning taking medicines and within the child-caregiver relationship. Continued study on pediatric ART adherence should account for differing perspectives of children and caregivers, as well as between status disclosed and nondisclosed children. Areas of future intervention should focus on child-caregiver relationships, disclosure of HIV status, and available nutritional and psychosocial support for children and their caregivers.