"It's all the time in my mind": Facilitators of adherence to antiretroviral therapy in a Tanzanian setting
"It's all the time in my mind": Facilitators of adherence to antiretroviral therapy in a Tanzanian setting
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DOI：
10.1016/j.socscimed.2009.02.037
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发表时间：
2009-05-01
影响因子：
5.4
通讯作者：
Jacobson, Mark
中科院分区：
文献类型：
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作者：
Watt, Melissa H.;Maman, Suzanne;Jacobson, Mark
尽管与工业化国家相比，非洲国家的艾滋病毒阳性患者对抗逆转录病毒治疗（ART）的依从性相对较高，但很少有研究探讨其原因。在此介绍的研究中，我们旨在了解坦桑尼亚阿鲁沙一家诊所接受免费抗逆转录病毒治疗和艾滋病毒相关服务的患者良好遵守抗逆转录病毒治疗的动态。 2006 年，我们在阿鲁沙的一个医疗保健中心对 6 名医疗保健提供者和 36 名患者进行了单独的半结构化访谈。访谈采用社会认知理论指导的访谈指南，用斯瓦希里语进行。所有采访均进行录音、用斯瓦希里语转录、翻译成英语并使用 ATLAS.ti 进行主题和模式编码。在接受采访的 36 名患者中（平均接受 ART 时间为 9.8 个月；范围为 1-23 个月），有 32 名患者报告在上个月完全遵守了治疗方案。尽管经济困难、抑郁、艾滋病毒披露率低以及与艾滋病毒相关的耻辱感很高，但自我报告的依从性仍然很高。有五个因素可以解释面对这些障碍时的良好依从性。首先，所有受访者在开始 ART 后都经历了健康状况的显着改善：这增强了他们对药物治疗的信心并激励他们坚持治疗。其次，他们认为能够履行家庭责任的需要促使受访者保持健康。第三，受访者制定了记住服药的具体策略，特别是通过将服药与日常活动或事件联系起来，使服药成为常态。第四，从他人那里获得的物质和情感支持促进了坚持。最后，受访者相信医疗保健提供者的建议和指示，他们经常强调坚持治疗。确定的促进因素与社会认知理论的构建一致，并强调了解决对依从性的多层次影响的干预措施的重要性。 (C) 2009 Elsevier Ltd. 保留所有权利。
Although HIV positive patients' adherence to antiretroviral therapy (ART) is relatively high in African nations, as compared with industrialized nations, few studies have explored why. In the research presented here we aimed to understand the dynamics of good adherence to ART among patients receiving free ART and HIV-related services from a clinic in Arusha, Tanzania. We conducted individual semi-structured interviews with 6 health care providers and 36 patients at a health care center in Arusha in 2006. Interviews were conducted in Swahili using interview guides informed by social cognitive theory. All interviews were audio-recorded, transcribed in Kiswahili, translated into English and coded for themes and patterns with ATLAS.ti. Of the 36 patients interviewed (mean time on ART 9.8 months; range 1-23 months), 32 reported perfect adherence in the previous month. Self-reported adherence was high despite economic hardship, depression, low rates of HIV disclosure and high perceived HIV-associated stigma. Five factors emerged to explain excellent adherence in the face of such barriers. First, all respondents experienced substantial improvements in their health after starting ART: this supported their confidence in the medication and motivated them to adhere. Second, their perceived need to be able to meet their family responsibilities motivated respondents to stay healthy. Third, respondents developed specific strategies to remember to take pills, particularly routinizing pill-taking by linking it with daily activities or events. Fourth, material and emotional support received from others facilitated adherence. Finally, respondents trusted the advice and instructions of their health care providers, who regularly emphasized adherence. The facilitating factors identified were consistent with the constructs of social cognitive theory and highlighted the importance of interventions that address multiple levels of influence on adherence. (C) 2009 Elsevier Ltd. All rights reserved.