Explaining antiretroviral therapy adherence success among HIV-infected children in rural Uganda: a qualitative study.

Explaining antiretroviral therapy adherence success among HIV-infected children in rural Uganda: a qualitative study.
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解释了乌干达农村艾滋病毒感染儿童的抗逆转录病毒疗法的依从性成功:一项定性研究。

DOI:
10.1007/s10461-014-0924-7
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发表时间:
2015-04
期刊:
影响因子:
4.4
通讯作者:
Haberer, Jessica E.
Haberer, Jessica E.
中科院分区:
医学2区
文献类型:
--
作者:
Olds, Peter K.;Kiwanuka, Julius P.;Ware, Norma C.;Tsai, Alexander C.;Haberer, Jessica E.

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高依从性对于实现艾滋病毒抗逆转录病毒疗法(ART)的临床益处至关重要,对儿童尤其具有挑战性。我们对感染艾滋病毒的乌干达儿童的照顾者进行了35次定性访谈,他们在一项实时ART依从性监测的纵向研究中进行了跟踪;18名参与者患有未检测到的艾滋病毒RNA,17名参与者患有可检测到的病毒。对病毒抑制状态视而不见的访谈获得了关于坚持经验、坚持的障碍和促进者以及社会支持的信息。使用归纳内容分析方法,我们将“缺乏资源”、“拉撒路效应”、“照顾者的责任感和承诺”以及“儿童的个人责任”确定为影响依从性的类别,并确定了照顾者社会支持的类型。在有病毒抑制的儿童中,对儿童的未来寄予厚望,并随时获得私人工具支持,似乎特别重要。这些发现表明,临床咨询应该探索照顾者对孩子未来的看法,以及在克服依从性障碍方面获得支持的能力。
High adherence is critical for achieving clinical benefits of HIV antiretroviral therapy (ART) and particularly challenging for children. We conducted 35 qualitative interviews with caregivers of HIV-infected Ugandan children who were followed in a longitudinal study of real-time ART adherence monitoring; 18 participants had undetectable HIV RNA, while 17 had detectable virus. Interviews blinded to viral suppression status elicited information on adherence experiences, barriers and facilitators to adherence, and social support. Using an inductive content analytic approach, we identified ‘lack of resources,’ ‘Lazarus effect,’ ‘caregiver's sense of obligation and commitment,’ and ‘child's personal responsibility’ as categories of influence on adherence, and defined types of caregiver social support. Among children with viral suppression, high hopes for the child's future and ready access to private instrumental support appeared particularly important. These findings suggest clinical counseling should explore caregivers' views of their children's futures and ability to access support in overcoming adherence barriers.
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