Distinctive barriers to antiretroviral therapy adherence among non-adherent adolescents living with HIV in Botswana.
Distinctive barriers to antiretroviral therapy adherence among non-adherent adolescents living with HIV in Botswana.
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DOI：
10.1080/09540121.2017.1344767
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发表时间：
2018-03
期刊：
影响因子：
1.7
通讯作者：
Lowenthal E
中科院分区：
文献类型：
--
作者：
Yang E;Mphele S;Moshashane N;Bula B;Chapman J;Okatch H;Pettitt E;Tshume O;Marukutira T;Anabwani G;Lowenthal E
与接受类似治疗的老年人和年轻人相比，青少年坚持接受艾滋病毒治疗的水平较低。我们在博茨瓦纳哈博罗内进行了一项300名青少年艾滋病毒治疗依从性的纵向研究，我们故意从这些青少年中抽取了依从性最高和最低的青少年。有多种客观和主观的依从性测量方法，研究参与者是根据一年期间的持续模式选择的，要么是优秀的，要么是糟糕的。焦点小组讨论（FGD）和深度访谈（IDI）与青少年和他们的照顾者的一个子集进行，目的是揭示障碍和促进依从性。焦点小组按参与者的依从性分类分开。在转录本编码之后，基于参与者的依从性分类开发了矩阵，以澄清具有不同依从性特征的个体产生的主题差异。包括47名青少年和25名成年人。未坚持治疗的青少年年龄大于坚持治疗的青少年（中位年龄为18岁（IQR 16-19岁）vs. 14岁（IQR 12-15岁）），两组的中位治疗时间均接近10年。日常活动受到干扰、对耻辱和歧视的担忧、副作用、否认艾滋病毒感染状况以及粮食不安全，这些都是持续坚持服药者和不太坚持服药者面临的挑战。结果预期低、治疗疲劳、心理健康和物质使用问题以及期望和获得的社会支持之间的不匹配仅在依从性差的青少年及其照顾者中进行了讨论。仅在非依从组的青少年和照顾者中提出的挑战是假设产生的，确定可能比依从组和非依从组的青少年面临的挑战更容易导致不良结果的领域。这些因素对不良预后的影响应在未来的研究中加以探讨。
Levels of adherence to HIV treatment are lower among adolescents compared with older and younger individuals receiving similar therapies. We purposely sampled the most and least adherent adolescents from a 300-adolescent longitudinal HIV treatment adherence study in Gaborone, Botswana. Multiple objective and subjective measures of adherence were available and study participants were selected based on sustained patterns of either excellent or poor adherence over a one-year period. Focus group discussions (FGD) and in-depth interviews (IDI) were conducted with the adolescents and a subset of their caregivers with the goal of revealing barriers and facilitators of adherence. Focus groups were segregated by adherence classification of the participants. Following coding of transcripts, matrices were developed based on participants’ adherence classifications in order to clarify differences in themes generated by individuals with different adherence characteristics. 47 adolescents and 25 adults were included. The non-adherent adolescents were older than the adherent adolescents (median age 18 years (IQR 16–19) vs. 14 years (IQR 12–15 years)), with median time on treatment near 10 years in both groups. Interference with daily activities, concerns about stigma and discrimination, side effects, denial of HIV status, and food insecurity arose as challenges to adherence among both those who were consistently adherent and those who were poorly-adherent to their medications. Low outcome expectancy, treatment fatigue, mental health and substance use problems, and mismatches between desired and received social support were discussed only among poorly adherent adolescents and their caregivers. Challenges raised only among adolescents and caregivers in the non-adherent groups are hypothesis-generating, identifying areas that may have a greater contribution to poor outcomes than challenges faced by both adherent and non-adherent adolescents. The contribution of these factors to poor outcomes should be explored in future studies.
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影响因子：
3.6
作者：
Fales, Jessica L.;Essner, Bonnie S.;Palermo, Tonya M.
通讯作者：
Palermo, Tonya M.
DOI：
10.1097/qai.0000000000000994
发表时间：
2016-08-15
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
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通讯作者：
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作者：
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通讯作者：
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影响因子：
2.6
作者：
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通讯作者：
Lowenthal, Elizabeth
影响因子：
3.8
作者：
Claborn, Kasey R.;Meier, Ellen;Leffingwell, Thad R.
通讯作者：
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