Knight Rod, Small Will, Thomson Kim, Gilbert Mark, Shoveller Jean
Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
BMC Public Health. 2016 Mar 15;16:262. doi: 10.1186/s12889-016-2943-y.
Despite evidence supporting the preventative potential of HIV Treatment as Prevention (TasP), scientific experts and community stakeholders have suggested that the success of TasP at the population level will require overcoming a set of complex and population-specific implementation challenges. For example, the factors that might influence decisions to initiate 'early' treatment have yet to be thoroughly understood; neither have questions about the factors that enhance or impede their ability to achieve long-term adherence to ARVs or the social norms regarding various treatment regimens been examined in detail. This knowledge gap may hamper opportunities to effectively develop public health practices that are informed by the various challenges and opportunities related to TasP implementation and scale up.
Drawing on 50 in-depth, individual interviews with young men ages 18-24 in Vancouver, Canada, this study examines young men's perspectives regarding factors that might affect their engagement with TasP.
While findings from the current study indicate young men generally have a high receptiveness to TasP, our findings also identify key social and structural forces that will warrant ongoing consideration for TasP implementation. For example, participants described how an enhanced awareness regarding treatment (including awareness of the universal availability of treatment in Vancouver) would be a necessary, but not sufficient, condition to decide to endorse TasP. Their decisions about engaging in HIV care in the context of TasP (e.g., HIV testing, treatment initiation, long-term adherence) also appear to be contingent on their ability to negotiate or 'balance' the risks and benefits to themselves and others. The findings also offer insight into the complex and sometimes controversial narratives that continue to emerge regarding risk compensation practices in the context of TasP.
Based on the results of this study, we identify several areas that hold promise for informing the effective scale up of TasP, including new information regarding implementation adaptation strategies.
尽管有证据支持将艾滋病治疗作为预防手段（治疗即预防，TasP）具有预防潜力，但科学专家和社区利益相关者表示，要使TasP在人群层面取得成功，需要克服一系列复杂且因人群而异的实施挑战。例如，可能影响启动“早期”治疗决策的因素尚未得到充分理解；关于增强或阻碍他们长期坚持抗逆转录病毒药物治疗能力的因素，以及关于各种治疗方案的社会规范等问题也未得到详细研究。这种知识差距可能会妨碍有效制定基于TasP实施和扩大规模所涉及的各种挑战与机遇的公共卫生实践。
本研究对加拿大温哥华18至24岁的年轻男性进行了50次深入的个人访谈，以考察他们对可能影响其参与TasP的因素的看法。
虽然本研究的结果表明年轻男性总体上对TasP接受度较高，但我们的研究结果也确定了在实施TasP时需要持续考虑的关键社会和结构因素。例如，参与者描述了提高对治疗的认识（包括了解温哥华治疗的普遍可及性）是决定支持TasP的必要但不充分条件。他们在TasP背景下参与艾滋病护理的决策（如艾滋病检测、开始治疗、长期坚持）似乎也取决于他们能否权衡自身及他人的风险和益处。研究结果还深入揭示了在TasP背景下关于风险补偿做法不断出现的复杂且有时存在争议的说法。
基于本研究结果，我们确定了几个有望为有效扩大TasP规模提供信息的领域，包括有关实施适应策略的新信息。
