Perceived Stigma and Fear of Unintended Disclosure are Barriers in Medication Adherence in Adolescents with Perinatal HIV in Botswana: A Qualitative Study
Perceived Stigma and Fear of Unintended Disclosure are Barriers in Medication Adherence in Adolescents with Perinatal HIV in Botswana: A Qualitative Study
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DOI：
10.1155/2019/9623159
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发表时间：
2019-12-02
影响因子：
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通讯作者：
Josiah, Unaswi
中科院分区：
文献类型：
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作者：
Madiba, Sphiwe;Josiah, Unaswi
背景。对于患有围产期艾滋病毒 (ALPHIV) 的青少年来说，保持抗逆转录病毒治疗 (ART) 的最佳依从性是一项挑战，而且对于哪些因素有助于该人群的依从性，目前尚未达成共识。这项研究评估了 ALPHIV 患者自我报告的药物依从性，并探讨了阻碍或激励他们依从性的结构因素。方法。这项定性研究对博茨瓦纳一家教学医院传染病控制中心的 ALPHIV 进行了深入访谈。特意招募了 30 名年龄在 12 至 19 岁之间、了解自己艾滋病毒感染状况的青少年。使用主题方法和 NVivo 数据分析软件对转录的访谈进行分析。发现。不依从是跨年龄组和性别的一个问题。耻辱感是坚持 ART 的主要障碍。在寄宿学校就读的学生中，对耻辱和无意泄露的恐惧更为明显。青少年不愿意在室友面前和屋外服药。他们选择隐藏起来并私下服药，这导致了漏服药。人们越来越担心被人看到领取抗逆转录病毒疗法药物，这影响了预约就诊。当学校活动、给药时间和 ART 补充的预约诊所预约发生冲突时，对耻辱的恐惧也会影响行动的选择。家庭环境是依从性的主要促进因素。支持是青少年坚持和跟上诊所就诊的最强动力。就个人而言，对健康和长寿的渴望是坚持的主要动力。结论。对耻辱的恐惧塑造了青少年的依从行为。所感受到的耻辱影响了服药的时间和地点、去诊所补充抗逆转录病毒疗法以及自我披露艾滋病毒状况。有必要鼓励青少年向朋友自我披露自己的艾滋病毒感染状况，因为担心意外披露会加剧耻辱感。诊所预约的规划还应符合青少年的实际日常活动。
Background. Maintaining optimal adherence to antiretroviral treatment (ART) is a challenge for adolescents with perinatally HIV (ALPHIV), and there is little consensus on what factors contribute to adherence in this population. This study assessed self-reported medication adherence among ALPHIV and explored structural factors that hinder or motivate them to adhere. Methods. This qualitative study used in-depth interviews with ALPHIV at the infectious disease control centre of a teaching hospital in Botswana. Thirty adolescents aged 12-19 years who were aware of their HIV status were recruited purposively. Transcribed interviews were analysed using the thematic approach and NVivo data analysis software. Findings. Nonadherence was a problem across age groups and gender. Perceived stigma was a major barrier to ART adherence. The fear of stigma and unintended disclosure were more pronounced in those attending boarding school. The adolescents were not willing to take medication in front of roommates and outside of the home. They opted for hiding and taking medication in privacy which led to missed doses. The heightened fear of being seen collecting ART medication affected keeping appointments for clinic visits. Fear of stigma also influenced the choice of action when there was a clash between school activities, dosing times, and scheduled clinic appointments for ART refill. The home environment was the main facilitator for adherence. Support was the strongest motivator for adolescents to adhere and keep up with clinic visits. On a personal level, the desire to be healthy and live long was a major motivator to adhere. Conclusions. The fear of stigma shaped the adolescents' adherence behaviour. Perceived stigma affected the time and place to take medication, the visit to the clinic for ART refill, and self-disclosure of HIV status. There is need to encourage adolescents to self-disclose their HIV status to friends since the fear of unintended disclosure fuelled perceived stigma. Planning of clinic appointments should also be consistent with realistic daily activities of adolescents.