Dahab Mison, Charalambous Salome, Hamilton Robin, Fielding Katherine, Kielmann Karina, Churchyard Gavin J, Grant Alison D
Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
BMC Public Health. 2008 Feb 18;8:63. doi: 10.1186/1471-2458-8-63.
As ART programmes in African settings expand beyond the pilot stages, adherence to treatment may become an increasing challenge. This qualitative study examines potential barriers to, and facilitators of, adherence to ART in a workplace programme in South Africa.
We conducted key informant interviews with 12 participants: six ART patients, five health service providers (HSPs) and one human resources manager.
The main reported barriers were denial of existence of HIV or of one's own positive status, use of traditional medicines, speaking a different language from the HSP, alcohol use, being away from home, perceived severity of side-effects, feeling better on treatment and long waiting times at the clinic. The key facilitators were social support, belief in the value of treatment, belief in the importance of one's own life to the survival of one's family, and the ability to fit ART into daily life schedules.
Given the reported uncertainty about the existence of HIV disease and the use of traditional medicines while on ART, despite a programme emphasising ART counselling, there is a need to find effective ways to support adherence to ART even if the individual does not accept biomedical concepts of HIV disease or decides to use traditional medicines. Additionally, providers should identify ways to minimize barriers in communication with patients with whom they have no common language. Finally, dissatisfaction with clinical services, due to long waiting times, should be addressed.
随着非洲地区抗逆转录病毒治疗（ART）项目超越试点阶段不断扩大，坚持治疗可能会成为日益严峻的挑战。这项定性研究调查了南非一项职场项目中ART治疗坚持的潜在障碍和促进因素。
我们对12名参与者进行了关键信息人访谈：6名ART患者、5名卫生服务提供者（HSPs）和1名人资经理。
报告的主要障碍包括否认感染艾滋病毒或自身阳性状态、使用传统药物、与卫生服务提供者语言不通、饮酒、离家在外、认为副作用严重、感觉治疗后病情好转以及在诊所等待时间长。关键促进因素包括社会支持、相信治疗的价值、相信自己的生命对家庭生存的重要性以及将ART融入日常生活安排的能力。
鉴于报告中提到的对艾滋病毒疾病存在的不确定性以及在接受ART治疗时使用传统药物的情况，尽管项目强调ART咨询，但即使个体不接受艾滋病毒疾病的生物医学概念或决定使用传统药物，也需要找到支持坚持ART治疗的有效方法。此外，提供者应确定方法，尽量减少与没有共同语言的患者沟通中的障碍。最后，应解决因等待时间长而导致的对临床服务的不满问题。
