Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, P,O,Box 2236, Moshi, Tanzania.
BMC Public Health. 2012 Aug 30;12:716. doi: 10.1186/1471-2458-12-716.
To design effective, tailored interventions to support antiretroviral therapy (ART) adherence, a thorough understanding of the barriers and facilitators of ART adherence is required. Factors at the individual and interpersonal level, ART treatment characteristics and health care factors have been proposed as important adherence determinants.
To identify the most relevant determinants of adherence in northern Tanzania, in-depth interviews were carried out with 61 treatment-experienced patients from four different clinics. The interviews were ad-verbatim transcribed and recurrent themes were coded.
Coding results showed that the majority of patients had basic understanding of adherence, but also revealed misconceptions about taking medication after alcohol use. Adherence motivating beliefs were the perception of improved health and the desire to live like others, as well as the desire to be a good parent. A de-motivating belief was that stopping ART after being prayed for was an act of faith. Facilitators of adherence were support from friends and family, and assistance of home based care (HBC) providers. Important barriers to ART adherence were the use of alcohol, unavailability of food, stigma and disclosure concerns, and the clinics dispensing too few pills. Strategies recommended by the patients to improve adherence included better Care and Treatment Centre (CTC) services, recruitment of patients to become Home Based Care ( HBC) providers, and addressing the problem of stigma through education.
This study underscores the importance of designing tailored, patient-centered adherence interventions to address challenges at the patient, family, community and health care level.
为了设计有效的、量身定制的干预措施来支持抗逆转录病毒治疗（ART）的依从性，需要彻底了解影响 ART 依从性的障碍和促进因素。个人和人际层面、ART 治疗特征和医疗保健因素等因素被认为是重要的依从性决定因素。
为了确定坦桑尼亚北部最相关的依从性决定因素，我们对来自四个不同诊所的 61 名有治疗经验的患者进行了深入访谈。访谈逐字记录下来，并对反复出现的主题进行了编码。
编码结果表明，大多数患者对依从性有基本的了解，但也揭示了一些关于饮酒后服药的误解。依从性的激励信念是认为健康状况得到改善，以及渴望像其他人一样生活，还有为人父母的愿望。不依从的信念是，在祈祷后停止服用 ART 是一种信仰行为。促进依从性的因素包括来自朋友和家人的支持，以及家庭为基础的护理（HBC）提供者的帮助。ART 依从性的重要障碍包括饮酒、食物缺乏、污名化和披露问题，以及诊所提供的药丸太少。患者建议的提高依从性的策略包括改善关怀和治疗中心（CTC）的服务、招募患者成为家庭为基础的护理（HBC）提供者，以及通过教育解决污名化问题。
本研究强调了设计针对患者、家庭、社区和医疗保健层面的挑战的量身定制、以患者为中心的依从性干预措施的重要性。
