A qualitative investigation of HIV treatment dispensing models and impacts on adherence among people living with HIV who use drugs.
A qualitative investigation of HIV treatment dispensing models and impacts on adherence among people living with HIV who use drugs.
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DOI：
10.1371/journal.pone.0246999
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
McNeil R
中科院分区：
文献类型：
--
作者：
Fleming T;Collins AB;Bardwell G;Fowler A;Boyd J;Milloy MJ;Small W;McNeil R
抗逆转录病毒治疗（ART）配药与治疗依从性密切相关。在非法药物使用人群中，他们在坚持治疗方面遇到更大的结构性障碍，直接给予抗逆转录病毒治疗（DAAT）通常被认为是比自我给药更能预测最佳坚持治疗的因素。在加拿大温哥华，吸毒并居住在低收入住房中的艾滋病毒感染者（PLHIV）是治疗支持的关键人群。除了ART自我管理之外，这一群体通常能够访问两个关键的DAAT模型，每日交付和每日取货。这项民族流行病学定性研究探讨了关键的配药模式如何影响生活在低收入住房中使用药物的艾滋病毒感染者的抗逆转录病毒治疗依从性，以及这如何受到结构脆弱性的影响。在2018年2月至5月期间进行了持续30-45分钟的半结构化访谈，其中31名使用药物的PLHIV从正在进行的使用药物的PLHIV前瞻性队列中招募。访谈进行录音，逐字转录，并使用QSR International的NVivo 12软件进行分析。访谈的重点是住房、吸毒和艾滋病毒管理。模型，约束机构被发现有负面影响的坚持和生活质量。治疗中断是由结构性弱点（例如，住房脆弱性），影响在某些分配模式下保持依从性的能力，并导致参与者考虑其他模式。使用DAAT模型的参与者，该模型考虑了他们的结构脆弱性（例如，流动性问题、住房不稳定），对这些模式的治疗依从性给予了肯定，但也承认了限制代理的因素，以及这可能对依从性和生活质量产生的负面影响。能够将ART整合到既定的常规中是支持ART坚持的关键。抗逆转录病毒治疗模式，占结构脆弱性的艾滋病毒感染者谁使用毒品和生活在低收入住房是必要的，住房为基础的支持可能是至关重要的，但这种模式的影响机构必须考虑，以确保最佳的坚持。
Antiretroviral therapy (ART) dispensing is strongly associated with treatment adherence. Among illicit drug-using populations, whom experience greater structural barriers to adherence, directly administered antiretroviral therapy (DAAT) is often regarded as a stronger predictor of optimal adherence over self-administered medications. In Vancouver, Canada, people living with HIV (PLHIV) who use drugs and live in low-income housing are a critical population for treatment support. This group is typically able to access two key DAAT models, daily delivery and daily pickup, in addition to ART self-administration. This ethno-epidemiological qualitative study explores how key dispensing models impact ART adherence among PLHIV who use drugs living in low-income housing, and how this is framed by structural vulnerability. Semi-structured interviews lasting 30–45 minutes were conducted between February and May 2018 with 31 PLHIV who use drugs recruited from an ongoing prospective cohort of PLHIV who use drugs. Interviews were audio-recorded, transcribed verbatim, and analyzed using QSR International’s NVivo 12 software. Interviews focused on housing, drug use, and HIV management. Models that constrained agency were found to have negative impacts on adherence and quality of life. Treatment interruptions were framed by structural vulnerabilities (e.g., housing vulnerability) that impacted ability to maintain adherence under certain dispensing models, and led participants to consider other models. Participants using DAAT models which accounted for their structural vulnerabilities (e.g., mobility issues, housing instability), credited these models for their treatment adherence, but also acknowledged factors that constrained agency, and the negative impacts this could have on both adherence, and quality of life. Being able to integrate ART into an established routine is key to supporting ART adherence. ART models that account for the structural vulnerability of PLHIV who use drugs and live in low-income housing are necessary and housing-based supports could be critical, but the impacts of such models on agency must be considered to ensure optimal adherence.
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影响因子：
5.2
作者：
Gwadz M;de Guzman R;Freeman R;Kutnick A;Silverman E;Leonard NR;Ritchie AS;Muñoz-Plaza C;Salomon N;Wolfe H;Hilliard C;Cleland CM;Honig S
通讯作者：
Honig S
DOI：
10.17269/cjph.108.5753
发表时间：
2017-01-01
影响因子：
4.3
作者：
Brownrigg, Bobbi;Taylor, Darlene;Ogilvie, Gina
通讯作者：
Ogilvie, Gina
影响因子：
3.4
作者：
Amram, O.;Shoveller, J.;Lima, V
通讯作者：
Lima, V
影响因子：
4.4
作者：
Kennedy MC;Kerr T;McNeil R;Parashar S;Montaner J;Wood E;Milloy MJ
通讯作者：
Milloy MJ
影响因子：
0.7
作者：
Gilbert, Dorie J.;Abel, Elizabeth;Zilberman, Margarita
通讯作者：
Zilberman, Margarita