对坦桑尼亚坦盖莱地区转诊医院青少年在接受抗逆转录病毒治疗（ART）期间经历的伦理挑战及依从性的定性研究。
Qualitative inquiry into adolescents' experience of ethical challenges during enrollment and adherence to antiretroviral therapy (ART) in Temeke Regional Referral Hospital, Tanzania.
机构信息
Department of Bioethics and Health Professionalism, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Department of Developmental Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
出版信息
BMC Med Ethics. 2022 Mar 9;23(1):22. doi: 10.1186/s12910-022-00762-3.
BACKGROUND
Adolescents living with human immunodeficiency virus (HIV) experience challenges, including lack of involvement in their care as well nondisclosure of HIV status, which leads to poor adherence to antiretroviral therapy (ART). Parents have authority over their children, but during adolescence there is an increasing desire for independence. The aim of the study was to explore adolescents' experience of challenges identified by adolescents ages 10-19 years attending HIV care and treatment at Temeke Regional Referral Hospital in Tanzania.
METHODS
An exploratory descriptive qualitative design was employed in the HIV Care and Treatment Centre (CTC) in the Out-Patient Department at the Temeke Regional Referral Hospital in Tanzania with adolescents living with HIV who were 10-19 years of age. A total of 22 adolescents participated in semi-structured face-to-face interviews after parental consent and adolescent assent were obtained. Participants were interviewed about their participation in decisions to be tested for HIV and enrolled in the CTC, concerns surrounding disclosure of their HIV status to the adolescent or to others, stigma and discrimination, and the effect of these challenges on their adherence to medication. All interviews were audio-taped, transcribed verbatim in Swahili, and back-translated to English. Data analysis included both inductive and deductive thematic analysis.
RESULTS
Qualitative themes identified included lack of participation in decisions about HIV testing, challenges to enrollment in care and treatment; issues around disclosure of HIV status, such as delays in disclosure to the adolescent and disclosure to other persons and benefits and harms of such disclosures; and factors supporting and interfering with adherence to ART, such as parental support, organizational (clinic) support and problems, and self-stigmatization and shame.
CONCLUSION
Lack of adolescents' involvement in their care decision making and delayed disclosure of HIV status to the adolescent were identified concerns, leading to poor adherence to ART among adolescents. Disclosure to others, especially teachers, helped adolescents at school to take their medication properly. Disclosure to others led to stigma and discrimination for some adolescents. More research is needed to better understand the role of disclosure and its benefits and challenges for HIV-positive adolescents in Tanzania.
背景
感染人类免疫缺陷病毒 (HIV) 的青少年面临着诸多挑战，包括参与自身医疗护理的机会不足以及 HIV 感染状态不公开，这导致他们对抗逆转录病毒治疗 (ART) 的依从性较差。父母对子女拥有权威，但在青少年时期，他们越来越渴望独立。本研究旨在探索坦桑尼亚坦噶地区转诊医院 HIV 护理和治疗中心 (CTC) 中，年龄在 10-19 岁的青少年所经历的挑战。
方法
在坦桑尼亚坦噶地区转诊医院门诊 HIV 护理和治疗中心 (CTC) 中，采用探索性描述性定性设计，对 10-19 岁感染 HIV 的青少年进行了研究。在获得父母同意和青少年同意后，共有 22 名青少年参加了半结构化的面对面访谈。参与者接受了有关他们参与 HIV 检测和入组 CTC 决策的访谈，讨论了向青少年或其他人透露 HIV 状况的问题，包括耻辱和歧视问题，以及这些挑战对他们坚持服药的影响。所有访谈均进行了录音，并用斯瓦希里语逐字记录，并回译为英语。数据分析包括归纳和演绎主题分析。
结果
确定的定性主题包括缺乏参与 HIV 检测决策的机会、参与护理和治疗的挑战；HIV 状况披露方面的问题，如向青少年延迟披露以及向其他人披露的好处和坏处；以及支持和干扰 ART 依从性的因素，如父母支持、组织（诊所）支持和问题以及自我污名化和羞耻感。
结论
青少年参与自身医疗护理决策的机会不足以及向青少年延迟披露 HIV 状况是关注的问题，导致青少年对 ART 的依从性较差。向他人，特别是教师披露病情，有助于青少年在校正确服药。向他人披露病情会给一些青少年带来耻辱和歧视。需要进一步研究，以更好地了解坦桑尼亚 HIV 阳性青少年披露的作用及其好处和挑战。
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