McNeil Ryan, Kerr Thomas, Coleman Bill, Maher Lisa, Milloy M J, Small Will
BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada.
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
AIDS Behav. 2017 Feb;21(2):402-409. doi: 10.1007/s10461-016-1470-2.
HIV Treatment as Prevention (TasP) initiatives promote antiretroviral therapy (ART) access and optimal adherence (≥95 %) to produce viral suppression among people living with HIV (PLHIV) and prevent the onward transmission of HIV. ART treatment interruptions are common among PLHIV who use drugs and undermine the effectiveness of TasP. Semi-structured interviews were conducted with 39 PLHIV who use drugs who had experienced treatment ART interruptions in a setting with a community-wide TasP initiative (Vancouver, Canada) to examine influences on these outcomes. While study participants attributed ART interruptions to "treatment fatigue," our analysis revealed individual, social, and structural influences on these events, including: (1) prior adverse ART-related experiences among those with long-term treatment histories; (2) experiences of social isolation; and, (3) breakdowns in the continuity of HIV care following disruptive events (e.g., eviction, incarceration). Findings reconceptualise 'treatment fatigue' by focusing attention on its underlying mechanisms, while demonstrating the need for comprehensive structural reforms and targeted interventions to optimize TasP among drug-using PLHIV.
“治疗即预防”（TasP）倡议旨在推动抗逆转录病毒疗法（ART）的可及性，并实现最佳依从性（≥95%），从而使艾滋病病毒感染者（PLHIV）实现病毒抑制，防止艾滋病病毒的进一步传播。在使用毒品的PLHIV中，ART治疗中断的情况很常见，这会削弱TasP的效果。我们对39名在社区范围开展TasP倡议的地区（加拿大温哥华）有过ART治疗中断经历的使用毒品的PLHIV进行了半结构化访谈，以研究影响这些结果的因素。虽然研究参与者将ART治疗中断归因于“治疗疲劳”，但我们的分析揭示了对这些事件的个人、社会和结构影响，包括：（1）有长期治疗史者先前与ART相关的不良经历；（2）社会隔离经历；以及，（3）在发生扰乱性事件（如被驱逐、监禁）后，HIV护理连续性的中断。研究结果通过关注“治疗疲劳”的潜在机制对其进行了重新概念化，同时表明需要进行全面的结构改革和有针对性的干预措施，以优化在使用毒品的PLHIV中实施的TasP。
