Tabatabai Julia, Namakhoma Ireen, Tweya Hannock, Phiri Sam, Schnitzler Paul, Neuhann Florian
Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Department of Infectious Diseases, Virology, University of Heidelberg, Heidelberg, Germany.
Reach Trust, Lilongwe, Malawi.
Glob Health Action. 2014 Sep 30;7:24795. doi: 10.3402/gha.v7.24795. eCollection 2014.
In recent years, scaling up of antiretroviral therapy (ART) in resource-limited settings moved impressively towards universal access. Along with these achievements, public health HIV programs are facing a number of challenges including the support of patients on lifelong therapy and the prevention of temporary/permanent loss of patients in care. Understanding reasons for treatment interruption (TI) can inform strategies for improving drug adherence and retention in care.
To evaluate key characteristics of patients resuming ART after TI at the Lighthouse Clinic in Lilongwe, Malawi, and to identify their reasons for interrupting ART.
This study uses a mixed methods design to evaluate patients resuming ART after TI. We analysed an assessment form for patients with TI using pre-defined categories and a comments field to identify frequently stated reasons for TI. Additionally, we conducted 26 in-depth interviews to deepen our understanding of common reasons for TI. In-depth interviews also included the patients' knowledge about ART and presence of social support systems. Qualitative data analysis was based on a thematic framework approach.
A total of 347 patients (58.2% female, average age 35.1±11.3 years) with TI were identified. Despite the presence of social support and sufficient knowledge of possible consequences of TI, all patients experienced situations that resulted in TI. Analysis of in-depth interviews led to new and distinct categories for TI. The most common reason for TI was travel (54.5%, n=80/147), which further differentiated into work- or family-related travel. Patients also stated transport costs and health-care-provider-related reasons, which included perceived/enacted discrimination by health care workers. Other drivers of TI were treatment fatigue/forgetfulness, the patients' health status, adverse drug effects, pregnancy/delivery, religious belief or perceived/enacted stigma.
To adequately address patients' needs on a lifelong therapy, adherence-counselling sessions require provision of problem-solving strategies for common barriers to continuous care.
近年来，资源有限地区扩大抗逆转录病毒疗法（ART）的规模在实现普遍可及方面取得了令人瞩目的进展。伴随着这些成就，公共卫生领域的艾滋病项目面临着诸多挑战，包括为接受终身治疗的患者提供支持以及防止患者在治疗过程中出现暂时/永久失访。了解治疗中断（TI）的原因有助于制定提高药物依从性和维持治疗的策略。
评估马拉维利隆圭灯塔诊所TI后重新开始接受ART治疗的患者的关键特征，并确定他们中断ART的原因。
本研究采用混合方法设计来评估TI后重新开始接受ART治疗的患者。我们使用预定义类别和评论字段分析了TI患者的评估表，以确定TI的常见原因。此外，我们进行了26次深入访谈，以加深对TI常见原因的理解。深入访谈还包括患者对ART的了解以及社会支持系统的存在情况。定性数据分析基于主题框架法。
共确定了347例有TI的患者（58.2%为女性，平均年龄35.1±11.3岁）。尽管存在社会支持且患者对TI的可能后果有足够了解，但所有患者都经历了导致TI的情况。对深入访谈的分析得出了TI的新的不同类别。TI最常见的原因是旅行（54.5%，n = 80/147），这又进一步细分为与工作或家庭相关的旅行。患者还提到了交通成本和与医疗服务提供者相关的原因，其中包括医护人员的感知/实际歧视。TI的其他驱动因素包括治疗疲劳/遗忘、患者的健康状况、药物不良反应、怀孕/分娩、宗教信仰或感知/实际耻辱感。
为了充分满足患者终身治疗的需求，依从性咨询会议需要提供针对持续治疗常见障碍的解决问题策略。
