Yang Elizabeth, Mphele Seipone, Moshashane Neo, Bula Boineelo, Chapman Jennifer, Okatch Harriet, Pettitt Ed, Tshume Ontibile, Marukutira Tafireyi, Anabwani Gabriel, Lowenthal Elizabeth
a Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.
b Department of Psychology , University of Botswana , Gaborone , Botswana.
AIDS Care. 2018 Feb;30(2):224-231. doi: 10.1080/09540121.2017.1344767. Epub 2017 Jun 23.
Levels of adherence to HIV treatment are lower among adolescents compared with older and younger individuals receiving similar therapies. We purposely sampled the most and least adherent adolescents from a 300-adolescent longitudinal HIV treatment adherence study in Gaborone, Botswana. Multiple objective and subjective measures of adherence were available and study participants were selected based on sustained patterns of either excellent or poor adherence over a one-year period. Focus group discussions (FGD) and in-depth interviews (IDI) were conducted with the adolescents and a subset of their caregivers with the goal of revealing barriers and facilitators of adherence. Focus groups were segregated by adherence classification of the participants. Following coding of transcripts, matrices were developed based on participants' adherence classifications in order to clarify differences in themes generated by individuals with different adherence characteristics. 47 adolescents and 25 adults were included. The non-adherent adolescents were older than the adherent adolescents (median age 18 years (IQR 16-19) vs. 14 years (IQR 12-15 years)), with median time on treatment near 10 years in both groups. Interference with daily activities, concerns about stigma and discrimination, side effects, denial of HIV status, and food insecurity arose as challenges to adherence among both those who were consistently adherent and those who were poorly-adherent to their medications. Low outcome expectancy, treatment fatigue, mental health and substance use problems, and mismatches between desired and received social support were discussed only among poorly adherent adolescents and their caregivers. Challenges raised only among adolescents and caregivers in the non-adherent groups are hypothesis-generating, identifying areas that may have a greater contribution to poor outcomes than challenges faced by both adherent and non-adherent adolescents. The contribution of these factors to poor outcomes should be explored in future studies.
与接受类似治疗的老年人和年轻人相比，青少年对艾滋病治疗的依从性较低。我们从博茨瓦纳哈博罗内一项针对300名青少年的艾滋病长期治疗依从性研究中，特意抽取了依从性最高和最低的青少年样本。该研究有多种客观和主观的依从性测量方法，研究参与者是根据他们在一年时间里持续表现出的极佳或极差的依从模式挑选出来的。我们对青少年及其部分照料者进行了焦点小组讨论（FGD）和深入访谈（IDI），目的是找出依从性的障碍和促进因素。焦点小组根据参与者的依从性分类进行了划分。在对访谈记录进行编码后，根据参与者的依从性分类编制了矩阵，以厘清具有不同依从特征的个体所产生的主题差异。研究共纳入了47名青少年和25名成年人。不依从的青少年比依从的青少年年龄大（中位年龄18岁（四分位间距16 - 19岁）对14岁（四分位间距12 - 15岁）），两组的中位治疗时间均接近10年。对日常活动的干扰、对耻辱和歧视的担忧、副作用、否认感染艾滋病毒以及粮食不安全等问题，对坚持服药的人和服药依从性差的人来说都是依从性方面的挑战。低结果预期、治疗疲劳、心理健康和物质使用问题，以及期望的社会支持与实际获得的社会支持之间的不匹配，仅在服药依从性差的青少年及其照料者中被提及。仅在不依从组的青少年和照料者中提出的挑战有助于提出假设，确定那些可能比依从和不依从的青少年都面临的挑战对不良结果有更大影响的领域。这些因素对不良结果的影响应在未来的研究中加以探讨。
