Influences on Adherence to ARVs in Uganda

描述(申请人提供)：新数据显示，撒哈拉以南非洲地区抗逆转录病毒治疗的依从率非常高--与美国的典型病例相当，甚至超过美国。然而，早期的成功可能反映出“蜜月期”，即抗逆转录病毒疗法启动后不久，病情严重的患者健康状况显著改善，因此有强烈的坚持意愿。当蜜月期结束时，遵从率可能会下降。就像在美国一样，在资源有限的环境中需要干预措施来支持遵守。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，以及这些环境对遵守有何影响。然后，这些理解可能会被转化为文化上合适的理论模型和干预措施，以支持坚持。这项为期两年的定性探索性研究建立在美国国立卫生研究院正在进行的定量研究的基础上。它将提供对促进者和遵守障碍的新理解，因为在资源有限的情况下，补贴的抗逆转录病毒疗法变得越来越容易获得。研究地点是乌干达姆巴拉拉姆巴拉拉大学教学医院的艾滋病毒诊所。数据收集包括对通过诊所接受抗逆转录病毒药物治疗的60名患者在一年内的四个时间点进行的多次深入访谈(总Ints：240)。还将对诊所活动进行观察，并与诊所工作人员进行访谈。类别构建的扎根理论方法将被用来：(1)确定和代表遵守的促进者和障碍；(2)确定已经到位的成功的基于临床的坚持支持努力的特征；以及(3)评估乌干达目前用于在非常不同的资源有限的情况下指导干预发展的三步坚持模式的“适合度”。实践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。

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.