Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, USA.
Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya.
BMC Health Serv Res. 2022 Jul 29;22(1):962. doi: 10.1186/s12913-022-08373-9.
Adolescents living with HIV (ALHIV) experience higher mortality and are more likely to have poor antiretroviral therapy (ART) adherence and unsuppressed viral load (VL) compared to adults. Enhanced adherence counseling (EAC) is a client-centered counseling strategy that aims to identify and address barriers to optimal ART use and can be tailored to the unique needs of adolescents. This study aimed to better understand adherence barriers among ALHIV with suspected treatment failure and their experience with EAC to inform future programming.
A qualitative study was conducted in Homa Bay and Turkana counties, Kenya in 2019 with adolescents and caregivers of children and adolescents living with HIV with suspected treatment failure after ≥6 months on ART and who had received ≥1 EAC sessions. Sixteen focus group discussions (FGDs) were conducted; five FGDs each were held with adolescents 12-14 years (n = 48) and 15-19 years (n = 36). Caregivers (n = 52) participated in six FGDs. Additionally, 17 healthcare workers providing pediatric/adolescent HIV services participated in in-depth interviews. Audio recordings were transcribed and translated from Kiswahili or Dholuo into English and coded using MAXQDA software. Data were thematically analyzed by participant group.
Participants identified adolescents' fear of being stigmatized due to their HIV status and their relationship with and level of support provided by caregivers. This underpinned and often undermined adolescents' ART-taking behavior and progress towards more independent medication management. Adolescents were generally satisfied with EAC and perceived it to be important in improving adherence and reducing VL. However, problems were noted with facility-based, individual EAC counseling, including judgmental attitudes of providers and difficulties traveling to and keeping EAC clinic appointments. Participant-suggested improvements to EAC included peer support groups in addition to individual counseling, allowing for greater flexibility in the timing and location of sessions and greater caregiver involvement.
The findings provide opportunities to better tailor EAC interventions to promote improved ALHIV adherence and caregiver-supported disease management. Multi-prong EAC interventions that include peer-led and community approaches and target adolescent and caregiver treatment literacy may improve EAC delivery, address issues contributing to poor adherence, and position adolescents to achieve viral suppression.
ClinicalTrials.gov : NCT04915469.
与成年人相比，感染艾滋病毒的青少年（ALHIV）死亡率更高，更有可能出现抗逆转录病毒治疗（ART）依从性差和病毒载量（VL）未得到抑制的情况。增强型依从性咨询（EAC）是一种以客户为中心的咨询策略，旨在识别和解决最佳 ART 使用的障碍，并可根据青少年的独特需求进行调整。本研究旨在更好地了解疑似治疗失败的 ALHIV 中的依从性障碍及其对 EAC 的体验，以为未来的规划提供信息。
2019 年在肯尼亚的霍马湾和图尔卡纳县进行了一项定性研究，研究对象为接受 ART 治疗≥6 个月且疑似治疗失败的儿童和青少年艾滋病毒感染者及其父母或监护人，他们已接受≥1 次 EAC 咨询。共进行了 16 次焦点小组讨论（FGD）；12-14 岁（n=48）和 15-19 岁（n=36）的青少年各进行了 5 次 FGD；52 名照顾者参加了 6 次 FGD。此外，17 名提供儿科/青少年艾滋病毒服务的卫生保健工作者参加了深入访谈。从斯瓦希里语或杜罗语转录和翻译的音频记录被翻译成英语，并使用 MAXQDA 软件进行编码。按参与者群体进行主题分析。
参与者确定了青少年因 HIV 状况而感到被污名化的恐惧，以及他们与照顾者的关系和获得的支持程度。这支撑着青少年的 ART 服药行为，并有助于他们朝着更独立的药物管理方向发展。青少年通常对 EAC 感到满意，并认为它对提高依从性和降低 VL 很重要。然而，在医疗机构进行的个人 EAC 咨询中存在一些问题，包括提供者的评判态度和难以前往并按时参加 EAC 诊所预约。参与者建议改进 EAC，包括除个人咨询外，还增加同伴支持小组，从而在时间和地点上更加灵活，并让照顾者更多地参与。
研究结果为更好地调整 EAC 干预措施以促进改善 ALHIV 依从性和照顾者支持的疾病管理提供了机会。多管齐下的 EAC 干预措施，包括同伴主导和社区方法，并针对青少年和照顾者的治疗知识，可能会改善 EAC 的实施，解决导致依从性差的问题，并使青少年能够实现病毒抑制。
ClinicalTrials.gov：NCT04915469。
