Nam Sara L, Fielding Katherine, Avalos Ava, Dickinson Diana, Gaolathe Tendani, Geissler P Wenzel
London School of Hygiene and Tropical Medicine, Infectious Diseases Epidemiology Unit, Keppel Street, London WC1E &HT, UK.
Soc Sci Med. 2008 Jul;67(2):301-10. doi: 10.1016/j.socscimed.2008.03.042. Epub 2008 May 1.
Adherence to antiretroviral therapy among HIV patients is the most important patient-enabled factor related to virological failure and can lead to drug resistance. It is important to avoid virological failure, especially in resource-limited settings where treatment options are limited and the effects of treatment failure are profound. This qualitative study aimed to identify the psycho-social factors related to adherence behaviour in Gaborone, Botswana, a high prevalence setting in southern Africa. One-to-one, in-depth interviews were conducted with adult antiretroviral patients in the private and public health sectors who had been on antiretroviral therapy for a minimum of 6 months. A grounded theory approach was adopted and patients were selected purposively and theoretical sampling determined the final sample size. Thirty-two patients were interviewed, 22 from the public-sector, the mean age was 9.5 years and 53% were women. We found that acceptance of HIV-status, the ability to avoid internalising stigmatising attitudes and identification of an encouraging confidante were key factors related to good adherence. Encouraging confidantes (including clinicians) and contributed to promoting hope and acceptance of HIV-status, enabling patients to develop a positive therapeutic relationship with their antiretrovirals and make lifestyle changes that promoted adherence. Active participation in a social network and a desire to avoid being thin and visibly identifiable as HIV-positive were also adherence-motivating factors. Conversely, participants who expressed some degree of denial about their HIV-status tended to express emotions associated with depression, and internalised stigma that inhibited the development of a relationship with a confidante. We feel it is important to identify individuals with HIV who are still in some degree of denial about their status and to identify depression among patients on antiretrovirals. This will enable more targeted, individualised support in the management of individuals' HIV disease.
艾滋病病毒（HIV）患者对抗逆转录病毒疗法的依从性是与病毒学治疗失败相关的最重要的患者自身因素，并且可能导致耐药性。避免病毒学治疗失败非常重要，尤其是在资源有限的环境中，那里的治疗选择有限，且治疗失败的影响深远。这项定性研究旨在确定与博茨瓦纳哈博罗内市（非洲南部一个高流行地区）依从行为相关的心理社会因素。对私立和公立卫生部门中接受抗逆转录病毒治疗至少6个月的成年抗逆转录病毒患者进行了一对一的深入访谈。采用了扎根理论方法，有目的地选择患者，理论抽样确定了最终样本量。采访了32名患者，其中22名来自公共部门，平均年龄为9.5岁，53%为女性。我们发现，接受HIV感染状况、避免将污名化态度内化的能力以及找到一位能给予鼓励的知己是与良好依从性相关的关键因素。能给予鼓励的知己（包括临床医生）有助于促进对HIV感染状况的希望和接受，使患者能够与抗逆转录病毒药物建立积极的治疗关系，并做出有助于依从性的生活方式改变。积极参与社交网络以及避免消瘦和明显被识别为HIV阳性的愿望也是促进依从性的因素。相反，对自己的HIV感染状况表示一定程度否认的参与者往往会表达与抑郁相关的情绪，以及抑制与知己建立关系的内化污名。我们认为，识别仍对自己的感染状况存在一定程度否认的HIV感染者以及识别抗逆转录病毒治疗患者中的抑郁症很重要。这将有助于在管理个人的HIV疾病时提供更有针对性、个性化的支持。
