Influences on Adherence to ARVs in Uganda

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坚持率很高——与美国的典型情况相当或超过美国。然而，早期的成功可能反映了一个“蜜月期”，即在开始抗逆转录病毒治疗后不久，重病患者的健康状况得到了显著改善，因此，他们有强烈的动力坚持治疗。当蜜月期结束时，依从率可能会下降。在资源有限的环境中，支持依从性的干预措施是必要的，就像在美国一样。然而，在这个国家开发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上与资源丰富的环境有何不同，以及对坚持的影响是什么。然后，这些理解可以转化为文化上适当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正在进行的美国国立卫生研究院资助的定量研究基础上。当在资源有限的环境中越来越多地获得补贴的抗逆转录病毒治疗时，它将提供对坚持治疗的促进因素和障碍的新理解。研究地点是乌干达姆巴拉拉大学教学医院的艾滋病诊所。数据收集包括在一年中的四个时间点对通过诊所接受抗逆转录病毒药物治疗的60名患者中的每一位进行多次深入访谈（总人数：240人）。还将进行对诊所活动的观察和对诊所工作人员的访谈。类别构建的基础理论方法将用于：(1)识别和表示依从性的促进因素和障碍，(2)描述已经到位的成功的基于临床的依从性支持工作，以及(3)评估乌干达三步依从性模型的“适合程度”，该模型目前用于指导在一个非常不同的资源有限的环境中的干预发展。实际的干预策略将作为干预设计和测试的基础，这将是本研究的下一步。

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.