Musiimenta Angella, Atukunda Esther C, Tumuhimbise Wilson, Haberer Jessica E
a Mbarara University of Science and Technology , Mbarara , Uganda.
b Harvard Medical School , Boston , MA , USA.
AIDS Care. 2018 Aug;30(sup5):S89-S96. doi: 10.1080/09540121.2018.1510107. Epub 2019 Jan 9.
Technology-based interventions for behavior change, such as adherence monitors and SMS text messages, can improve adherence to HIV antiretroviral therapy. It is unclear, however, how the effects of such interventions are maintained when interventions are withdrawn. We explored resiliency of people living with HIV in coping with adherence to antiretroviral therapy (ART) after withdrawing an adherence support intervention of real-time adherence monitors linked to SMS text messages at study closure. This is a qualitative study conducted with former participants of a pilot randomized controlled trial after study closure. Between April 2016 and November 2016, we used convenient sampling to interview 28 of the 62 participants from the pilot trial, which was conducted in rural Uganda. Interviews elicited information on experiences of taking ART in the absence of the intervention, coping strategies, and changes in social support interactions. Data were analyzed inductively using content analysis. Most participants demonstrated resilience through learning adherence from the intervention; and internalizing the habit of medication adherence. They seemed to have a sense of self-esteem, positive thinking, and access to supportive relationships. Other participants employed adaptive coping strategies, such as using alternative cues (e.g., alarms), accessing spiritual support, and adjusting their medication time to their routine. A few participants lacked resiliency, lost the habit and struggled with adherence. They were dependent on the intervention, appeared isolated and psychologically stressed, and were unable to overcome challenges associated with poor social support systems. Intervention-related benefits may or may not persist after the intervention is withdrawn. Contingent on individuals" underlying characteristics and relationships, participants manifested resiliency through learning and internalization, as well as using alternative coping strategies. Such resiliency could facilitate the use of short-term interventions, which are particularly important for resource-limited settings. Participants should be referred to available additional support at study closure when needed.
基于技术的行为改变干预措施，如依从性监测器和短信，可以提高对艾滋病毒抗逆转录病毒疗法的依从性。然而，尚不清楚在撤回干预措施后，此类干预措施的效果如何得以维持。我们在研究结束时撤回了与短信相关的实时依从性监测器这一依从性支持干预措施后，探讨了艾滋病毒感染者在应对抗逆转录病毒疗法（ART）依从性方面的恢复力。这是一项在研究结束后对一项试点随机对照试验的前参与者进行的定性研究。在2016年4月至2016年11月期间，我们采用便利抽样法，对在乌干达农村地区进行的试点试验中的62名参与者中的28名进行了访谈。访谈收集了在没有干预措施的情况下服用抗逆转录病毒疗法的经历、应对策略以及社会支持互动变化等方面的信息。使用内容分析法对数据进行归纳分析。大多数参与者通过从干预措施中学习依从性并将服药依从性习惯内化来展现恢复力。他们似乎有自尊心、积极的思维方式，并且能够获得支持性的人际关系。其他参与者采用了适应性应对策略，例如使用替代提示（如闹钟）、获得精神支持以及根据日常安排调整服药时间。少数参与者缺乏恢复力，失去了习惯，在依从性方面苦苦挣扎。他们依赖干预措施，显得孤立且心理压力大，并且无法克服与不良社会支持系统相关的挑战。干预措施撤回后，与干预相关的益处可能会持续，也可能不会持续。取决于个体的潜在特征和人际关系，参与者通过学习和内化以及使用替代应对策略展现出恢复力。这种恢复力有助于短期干预措施的使用，这对于资源有限的环境尤为重要。必要时，应在研究结束时为参与者提供可用的额外支持。
