Patient-Nominated, Community-Based HIV Treatment Supporters: Patient Perspectives, Feasibility, Challenges, and Factors for Success in HIV-Infected South African Adults
Patient-Nominated, Community-Based HIV Treatment Supporters: Patient Perspectives, Feasibility, Challenges, and Factors for Success in HIV-Infected South African Adults
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DOI：
10.1089/apc.2012.0348
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发表时间：
2013-02-01
影响因子：
4.9
通讯作者：
Chaisson, Richard E.
中科院分区：
文献类型：
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作者：
Duwell, Monique M.;Knowlton, Amy R.;Chaisson, Richard E.
本研究旨在描述南非艾滋病毒感染者中治疗支持者的经历，该试验参加了一项随机对照试验，比较了患者提名的治疗支持者给予部分直接观察抗逆转录病毒治疗（DOT-ART）与自我给予抗逆转录病毒治疗（Self-ART）的疗效。母体研究的结果显示，两组之间没有病毒学或持续的免疫差异，但在DOT-ART组中显示了显著的生存益处。一种假设是，这种生存优势可能是由治疗支持者在训练和参与方面的差异来解释的。在目前的研究中，对172名参与者进行了半结构化的离职面谈，结果表明，大多数参与者都与一个支持者保持着积极、满意的关系，通常是家庭成员或朋友。大多数患者（82.6%）认为支持者对药物依从性有帮助，组间无显著差异（p = 0.752）。此外，支持者提供了情感上、工具上和物质上的支持。DOT-ART患者比Self-ART患者更有可能报告他们的支持者帮助减少药物或酒精使用（p = 0.03）。患者认为支持者的可信度、可用性、良好的沟通和支持的互惠性是有利于成功关系的因素。这些结果表明：(1)在这种资源受限的环境下，患者提名的同伴是ART支持者的可行候选人；(2)除了提供药物援助外，治疗支持者有能力促进健康行为并提供其他类型的支持，这可能有助于改善结果，特别是通过加强培训；(3)可信赖性、可获得性、良好的沟通和互惠是成功的医助者关系的关键因素。
This study aimed to characterize the experience of having a treatment supporter among HIV-infected South African patients enrolled in a randomized controlled trial that compared the efficacy of patient-nominated treatment supporters administering partial directly observed antiretroviral therapy (DOT-ART) versus self-administered ART (Self-ART). Results of the parent study showed no virologic or sustained immunologic differences between groups, but revealed a significant survival benefit among the DOT-ART group. One hypothesis is that this survival benefit may be explained by differences in the training and involvement of the treatment supporters between groups. In the current study, results from a semi-structured exit interview of 172 participants indicate that most participants in both arms maintained a positive, satisfying relationship with a single supporter, typically family member or friend. Most patients (82.6%) perceived supporters as helpful with medication adherence, with no significant difference between groups (p = 0.752). Additionally, supporters provided emotional, instrumental, and material support. DOT-ART patients were more likely than Self-ART patients to report that their supporter helped to decrease drug or alcohol use (p = 0.03). Patients identified supporter trustworthiness, availability, good communication and reciprocity of support as factors beneficial to a successful relationship. These results suggest: (1) Patient-nominated peers are feasible candidates for ART supporters in this resource-constrained setting; (2) In addition to assistance with medications, treatment supporters have the capacity to promote healthy behaviors and provide other types of support, which may contribute to improved outcomes, particularly with enhanced training; (3) Trustworthiness, availability, good communication, and reciprocity are key factors in a successful patient-supporter relationship.