Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, 5005, Australia.
School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, 4412, Addis Ababa, Ethiopia.
BMC Infect Dis. 2020 Nov 23;20(1):879. doi: 10.1186/s12879-020-05618-y.
Effective self-management is an important consideration for adults living with HIV on therapy to enable people to maintain their health and well-being whilst living with chronic HIV. Although numerous attempts have been made to implement and improve HIV self-management practice, there is limited evidence on effective self-management strategies, particularly in sub-Saharan Africa. This study aimed to identify the level and factors influencing the self-management practice of adults living with HIV on antiretroviral therapy.
A cross-sectional survey was conducted on a sample of 415 adults living with HIV on antiretroviral therapy at a major referral hospital in Northwest Ethiopia using convenience sampling. A theory of self-management - the Individual and Family Self-Management Theory - guided the study design, analysis and presentation of the data. A face-to-face survey tool was administered for data collection, and the data were entered and analyzed using SPSS version 25.0.
Over half (58.1%) of the respondents were female. Many of the respondents did not know their HIV stage (76.9%) but reported adequate knowledge of their treatment (79.5%). The mean self-management score was 1.94 0.22 out of a total score of 3. Female gender was associated with decreased self-management. Contextual factors (gender, educational level, job status, income, living in a rural area, and awareness of HIV stage) explained 8.2% of the variance in self-management. The explanatory power increased by 9.2% when self-management process variables (self-efficacy, setting a goal, knowledge of antiretroviral therapy, HIV disclosure, and use of reminders) were added. Intervention-focused variables (encouraging disclosure and adherence support) increased the proportion of explained variance by 2.3%.
The findings of the study indicate that the level of self-management practice amongst the population studied was low compared to international literature. Our study findings support the theoretical model and previously identified factors influencing HIV self-management. The most important predictors of lower self-management practice in Ethiopia were female gender, illiteracy, lack of awareness of HIV stage, low self-efficacy, absence of reminders, lack of encouragement to disclose and absence of adherence support. HIV care providers should seek ways to empower and support adults living with HIV to self-manage, particularly through enhancing self-efficacy and encouraging the use of reminders.
有效的自我管理对于接受治疗的 HIV 感染者成年人来说是一个重要的考虑因素，这有助于他们在患有慢性 HIV 的同时保持健康和幸福感。尽管已经尝试实施和改进 HIV 自我管理实践，但在撒哈拉以南非洲地区，关于有效的自我管理策略的证据有限。本研究旨在确定接受抗逆转录病毒治疗的 HIV 感染者成年人的自我管理实践水平和影响因素。
本研究采用便利抽样，在埃塞俄比亚西北部一家主要转诊医院的 415 名接受抗逆转录病毒治疗的 HIV 感染者成年人中进行了横断面调查。个体和家庭自我管理理论指导了研究设计、分析和数据呈现。使用面对面的调查工具收集数据，使用 SPSS 版本 25.0 录入和分析数据。
超过一半（58.1%）的受访者为女性。许多受访者不知道自己的 HIV 阶段（76.9%），但报告说对治疗有足够的了解（79.5%）。自我管理评分平均为 3 分制中的 1.94±0.22 分。女性与自我管理能力下降有关。背景因素（性别、教育水平、工作状况、收入、居住在农村地区和对 HIV 阶段的认识）解释了自我管理的 8.2%差异。当加入自我管理过程变量（自我效能感、设定目标、对抗逆转录病毒疗法的了解、HIV 披露和使用提醒）后，解释能力增加了 9.2%。干预重点变量（鼓励披露和坚持支持）使解释方差的比例增加了 2.3%。
研究结果表明，与国际文献相比，研究人群的自我管理实践水平较低。我们的研究结果支持理论模型和以前确定的影响 HIV 自我管理的因素。在埃塞俄比亚，自我管理实践水平较低的最重要预测因素是女性、文盲、缺乏对 HIV 阶段的认识、自我效能感低、没有提醒、缺乏鼓励披露和缺乏坚持支持。HIV 护理提供者应寻求方法来增强和支持 HIV 感染者成年人进行自我管理，特别是通过增强自我效能感和鼓励使用提醒。
