Barroso Julie, Leblanc Natalie M, Flores Dalmacio
J Assoc Nurses AIDS Care. 2017 Jul-Aug;28(4):462-478. doi: 10.1016/j.jana.2017.02.007. Epub 2017 Feb 22.
Antiretroviral therapy (ART) improves the health and longevity of people living with HIV infection (PLWH) and also prevents transmission of the virus. Yet, lack of adherence to ART regimens has been a persistent problem, even with simpler regimens. Guidelines that deal with ART adherence are based almost solely on quantitative studies; this focus ignores the context and complexity of patients' lives. Guidelines are also focused on the individual. We argue that the solution is to include the broader communities in which patients live, and to deal with systemic disparities that persist worldwide; this can be done in part through demedicalizing HIV care for healthy PLWH. We present findings from a qualitative meta-synthesis of 127 studies conducted around the world on the last two pillars of the HIV treatment cascade: starting and remaining on ART until optimal viral suppression is achieved. We use Maslow's hierarchy of needs to frame our findings.
抗逆转录病毒疗法（ART）可改善艾滋病毒感染者（PLWH）的健康状况并延长其寿命，还能预防病毒传播。然而，即使采用更简单的治疗方案，坚持ART治疗方案一直是个持续存在的问题。处理ART依从性的指南几乎完全基于定量研究；这种关注忽略了患者生活的背景和复杂性。指南也侧重于个体。我们认为，解决办法是让患者生活的更广泛社区参与进来，并应对全球持续存在的系统性差异；这可以部分通过对健康的PLWH进行艾滋病护理非医学化来实现。我们展示了对全球范围内围绕艾滋病毒治疗级联的最后两个支柱进行的127项研究的定性综合分析结果：开始并持续接受ART治疗，直至实现最佳病毒抑制。我们使用马斯洛需求层次理论来阐述我们的研究结果。
