Ahmed Ali, Dujaili Juman Abdulelah, Jabeen Musarat, Umair Malik Muhammad, Chuah Lay-Hong, Hashmi Furqan Khurshid, Awaisu Ahmed, Chaiyakunapruk Nathorn
School of Pharmacy, Monash University, Subang Jaya, Malaysia.
Department of Pharmacy, Quaid-I-Azam University, Islamabad, Pakistan.
Front Pharmacol. 2022 Jan 28;12:807446. doi: 10.3389/fphar.2021.807446. eCollection 2021.
With the increased availability of safe antiretroviral therapy (ART) in recent years, achieving optimal adherence and patient retention is becoming the biggest challenge for people living with HIV (PLWH). Care retention is influenced by several socioeconomic, socio-cultural, and government policies during the COVID-19 pandemic. Therefore, we aim to explore barriers and facilitators to adherence to ART among PLWH in Pakistan in general and COVID-19 pandemic related in particular. Semi-structured interviews were conducted among 25 PLWH from December 2020 to April 2021 in the local language (Urdu) at the ART centre of Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Interviews were audio-recorded in the local Urdu language, and bilingual expert (English, Urdu) transcribed verbatim, coded for themes and sub-themes, and analyzed using a phenomenological approach for thematic content analysis. Stigma and discrimination, fear of HIV disclosure, economic constraints, forgetfulness, religion (Ramadan, spiritual healing), adverse drug reactions, lack of social support, alternative therapies, and COVID-19-related lock-down and fear of lesser COVID-19 care due to HIV associated stigma were identified as barriers affecting the retention in HIV care. At the same time, positive social support, family responsibilities, use of reminders, the beneficial impact of ART, and initiation of telephone consultations, courier delivery, and long-term delivery of antiretrovirals during COVID-19 were identified as facilitators of HIV retention. Improving adherence and retention is even more challenging due to COVID-19; therefore, it requires the integration of enhanced access to treatment with improved employment and social support. HIV care providers must understand these reported factors comprehensively and treat patients accordingly to ensure the continuum of HIV care. A coordinated approach including different stakeholders is required to facilitate patient retention in HIV care and consequently improve the clinical outcomes of PLWH.
近年来，随着安全抗逆转录病毒疗法（ART）的可及性增加，实现最佳依从性和患者留存率正成为艾滋病毒感染者（PLWH）面临的最大挑战。在新冠疫情期间，留存率受到多种社会经济、社会文化和政府政策的影响。因此，我们旨在探讨巴基斯坦艾滋病毒感染者中，尤其是与新冠疫情相关的，坚持接受抗逆转录病毒疗法的障碍和促进因素。2020年12月至2021年4月期间，在巴基斯坦伊斯兰堡巴基斯坦医学科学研究所的抗逆转录病毒治疗中心，用当地语言（乌尔都语）对25名艾滋病毒感染者进行了半结构化访谈。访谈用当地乌尔都语进行录音，由双语专家（英语、乌尔都语）逐字转录，编码为主题和子主题，并采用现象学方法进行主题内容分析。耻辱和歧视、对披露艾滋病毒的恐惧、经济限制、健忘、宗教（斋月、精神治疗）、药物不良反应、缺乏社会支持、替代疗法，以及与新冠疫情相关的封锁和因艾滋病毒相关耻辱感而担心获得的新冠护理较少，被确定为影响艾滋病毒护理留存率的障碍。同时，积极的社会支持、家庭责任、使用提醒、抗逆转录病毒疗法的有益影响，以及在新冠疫情期间启动电话咨询、快递服务和长期提供抗逆转录病毒药物，被确定为艾滋病毒留存的促进因素。由于新冠疫情，提高依从性和留存率更具挑战性；因此，需要将增加治疗可及性与改善就业和社会支持相结合。艾滋病毒护理提供者必须全面了解这些报告的因素，并据此治疗患者，以确保艾滋病毒护理的连续性。需要一种包括不同利益相关者的协调方法，以促进艾滋病毒感染者在护理中的留存率，从而改善艾滋病毒感染者的临床结局。
