Social Intervention Group, School of Social Work, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, United States.
Social Intervention Group, School of Social Work, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, United States.
Int J Drug Policy. 2018 Dec;62:43-50. doi: 10.1016/j.drugpo.2018.08.014. Epub 2018 Oct 22.
BACKGROUND: HIV-infected people who inject drugs (PWID) are particularly vulnerable to suboptimal ART adherence. The fastest-growing HIV epidemics globally are driven by injection drug use, but only a small percentage of HIV-positive PWID have achieved viral suppression. Virally suppressed individuals have better HIV-related health outcomes and effectively no risk of transmitting HIV to others. Hence, ART adherence is important for both HIV treatment and HIV prevention. There is a paucity of data on barriers and facilitators of ART adherence among PWID in low and middle income countries, which is problematic given the growing HIV epidemics among PWID in these countries. METHODS: Using the Theory of Triadic Influence, this paper examines individual, interpersonal, and structural barriers and facilitators of ART adherence among HIV-positive PWID in four cities in Kazakhstan. Eight focus groups were conducted (two in each city) with a total of 57 participants. Data were coded and analyzed by three researchers. RESULTS: We found a number of barriers and facilitators to ART adherence among PWID at the individual, interpersonal, and structural levels. Individual barriers to ART adherence include misperceptions about ART, forgetfulness due to the effects of illicit drug use, and medication side effects. Interpersonal facilitators of ART adherence include social support and good relationships with healthcare providers. Structural barriers include poverty, legal challenges, disruptions in the ART supply, and stigma and discrimination. CONCLUSION: The paper highlights important factors related to ART adherence for HIV-positive PWID and identifies potential strategies for intervention efforts, including couple-based interventions, electronic reminders, linkage to drug treatment services, and patient navigation. Effectively enhancing adherence to ART among PWID will likely require multi-level approaches and strategies. Further research should be conducted on potential methods and interventions for improving ART adherence among this vulnerable population.
背景：感染 HIV 的吸毒者（吸毒者）特别容易出现 ART 依从性不佳的情况。目前，在全球范围内，HIV 感染率增长最快的原因是注射毒品，但只有一小部分 HIV 阳性吸毒者实现了病毒抑制。病毒抑制的个体具有更好的 HIV 相关健康结果，并且实际上没有将 HIV 传播给他人的风险。因此，ART 依从性对于 HIV 治疗和 HIV 预防都很重要。在中低收入国家，吸毒者中 ART 依从性的障碍和促进因素的数据很少，考虑到这些国家中吸毒者的 HIV 感染率不断增长，这是一个问题。
方法：本文使用三元影响理论，研究了哈萨克斯坦四个城市中 HIV 阳性吸毒者的 ART 依从性的个体、人际和结构障碍和促进因素。共进行了 8 个焦点小组（每个城市 2 个），共有 57 名参与者。由 3 名研究人员对数据进行编码和分析。
结果：我们发现吸毒者在个人、人际和结构层面上存在许多 ART 依从性的障碍和促进因素。ART 依从性的个体障碍包括对 ART 的误解、由于非法药物使用的影响而健忘以及药物副作用。ART 依从性的人际促进因素包括社会支持和与医疗保健提供者的良好关系。结构障碍包括贫困、法律挑战、ART 供应中断以及耻辱和歧视。
结论：本文强调了与 HIV 阳性吸毒者 ART 依从性相关的重要因素，并确定了干预措施的潜在策略，包括基于夫妻的干预措施、电子提醒、与药物治疗服务的联系以及患者导航。有效地提高吸毒者对 ART 的依从性可能需要多层次的方法和策略。应进一步研究改善这一弱势群体对 ART 依从性的潜在方法和干预措施。
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