Influences on Adherence to ARVs in Uganda

对乌干达抗逆转录病毒药物依从性的影响

• 批准号: 7244129
• 负责人: NORMA C WARE
• 金额: $ 20.78万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-05-15 至 2009-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7244129
• 关键词: AIDS/HIV problem; Accounting; Address; Adherence; Africa South of the Sahara; Anti-Retroviral Agents; Categories; Classification; Clinic; Clinic Activity; Clinical; Clinical Data; Count; Country; Data; Data Collection; Depth; Development; Drops; Drug resistance; Empirical Research; Environment; Facility Construction Funding Category; Failure; Funding; Future; Goals; HIV; Health; Home environment; Individual; Intervention; Interview; Investigation; Knowledge; Measures; Methods; Modeling; Morbidity - disease rate; Morphologic artifacts; Patients; Population Heterogeneity; Prevention; Process; Rate; Reporting; Research; Research Personnel; Resources; Site; Study models; Teaching Hospitals; Testing; Theoretical model; Time; Translating; Transplantation; Uganda; Universities; Viral; antiretroviral therapy; base; design; drug resistant virus; experience; mortality; pill; programs; scale up; socioeconomics; success; theories; therapy design; therapy development

DESCRIPTION (provided by applicant): Emerging data reveal excellent rates of adherence to antiretroviral therapy in sub-Saharan Africa - rates comparable to or surpassing those typically seen in the U.S. However, early successes may reflect a "honeymoon period," a time shortly after initiation of ARV therapy when very ill patients experience dramatic health gains and as a result, are strongly motivated to adhere. When the honeymoon period ends, adherence rates are likely to drop. Interventions to support adherence are needed in resource-limited settings, as they are in the U.S. However, interventions developed in this country cannot simply be transplanted to different environments. The first step in developing feasible, effective and sustainable interventions for resource-limited settings is to understand how these settings differ - culturally as well as socioeconomically - from resource-rich contexts and what the implications are for adherence. These understandings may then be translated to produce culturally appropriate theoretical models and interventions for adherence support. This two-year, qualitative, exploratory study builds upon ongoing NIH-funded quantitative research. It will provide new understandings of facilitators and barriers to adherence at a time when subsidized ARV therapy is becoming increasingly available in resource-limited settings. The study site is the HIV clinic at Mbarara University Teaching Hospital, Mbarara, Uganda. Data collection consists of multiple, in-depth interviews conducted at four time points over one year for each of 60 patients receiving ARVs through the clinic (Total Ints: 240). Observations of clinic activities and interviews with clinic staff will also be carried out. Grounded theory methods of category construction will be used to: (1) identify and represent facilitators and barriers to adherence, (2) characterize successful clinic-based adherence support efforts already in place, and (3) assess "degree-of-fit" for Uganda of a three-step model of adherence currently being used to guide intervention development in a very different resource-limited setting. Practical intervention strategies will be derived as the basis for intervention design and testing, which follow as next steps from this research.

描述（由申请人提供）：新出现的数据显示，撒哈拉以南非洲地区抗逆转录病毒治疗的依从性非常好，与美国的典型水平相当或超过美国。然而，早期的成功可能反映了“蜜月期”，即开始抗逆转录病毒治疗后不久，重病患者经历了巨大的健康收益，因此有强烈的依从动机。当蜜月期结束时，遵守率可能会下降。在资源有限的情况下，需要采取干预措施来支持依从性，就像在美国一样。然而，在这个国家制定的干预措施不能简单地移植到不同的环境中。为资源有限的环境制定可行、有效和可持续的干预措施的第一步是了解这些环境在文化和社会经济方面与资源丰富的环境有何不同，以及对坚持的影响。这些理解，然后可以被翻译，以产生文化上适当的理论模型和干预措施，坚持支持。这项为期两年的定性探索性研究建立在NIH资助的定量研究基础上。它将提供新的理解的促进者和障碍，坚持的时候，补贴抗逆转录病毒疗法越来越多地提供在资源有限的环境。研究地点是乌干达姆巴拉拉大学教学医院的HIV诊所。数据收集包括在一年内的四个时间点对60名通过诊所接受抗逆转录病毒药物治疗的患者进行多次深入访谈（总人数：240）。还将对诊所活动进行观察，并与诊所工作人员进行面谈。类别构建的扎根理论方法将用于：（1）识别和代表依从性的促进者和障碍，（2）描述已经到位的成功的基于诊所的依从性支持工作，以及（3）评估乌干达目前用于指导干预开发的三步依从性模型的“适合度”。实际的干预策略将作为干预设计和测试的基础，这是本研究的下一步。