School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Afr J AIDS Res. 2023 Jul;22(2):123-130. doi: 10.2989/16085906.2023.2213211. Epub 2023 Jun 20.
Optimal adherence to antiretroviral therapy (ART) is crucial for the effective management of HIV. Mental disorders often co-occur with HIV infection which often compromises ART adherence. Little is known about ART adherence in psychiatric settings in sub-Saharan Africa. This study aimed at exploring the health care providers' perspectives on ART adherence among psychiatric inpatients. The study further assessed the facilitators and strategies enhancing ART adherence in hospitalised psychiatric patients. In-depth interviews were conducted with 25 health care providers at the Sbrana Psychiatric Hospital in Botswana. Interviews were focused on barriers and facilitators to psychiatric inpatients' adherence to ART, and strategies and recommendations to support adherence. Data were manually analysed using a thematic analysis approach. Key barriers were lack of insight, HIV-related stigma, lack of HIV-related knowledge, antiretroviral side effects and delays in re-initiating ART. Facilitators of ART adherence included motivation to be discharged from the hospital, fear of being sick, peer support, longer duration of hospitalisation, good provider-patient relationships, good diet, privacy and confidentiality and a single-tablet regimen. Health care providers described the various strategies currently used to support adherence, including directly observed therapy and family support, and recommended potential approaches to enhance psychiatric inpatient adherence to ART, including the use of injectable antiretrovirals and the introduction of halfway house centres. Findings from this study revealed unique insights into the numerous factors that influence ART adherence among psychiatric inpatients, and underscore the need to implement tailored strategies to support ART adherence in this population with complex health needs.
优化抗逆转录病毒疗法 (ART) 的依从性对于有效管理 HIV 至关重要。精神障碍常常与 HIV 感染同时发生，这往往会影响 ART 的依从性。在撒哈拉以南非洲的精神科环境中，ART 依从性的情况知之甚少。本研究旨在探讨精神科住院患者的医护人员对 ART 依从性的看法。本研究还评估了促进住院精神科患者 ART 依从性的促进因素和策略。在博茨瓦纳的 Sbrana 精神病院，对 25 名医护人员进行了深入访谈。访谈重点是精神科住院患者对 ART 依从性的障碍和促进因素，以及支持依从性的策略和建议。使用主题分析方法对手动分析数据。主要障碍包括缺乏洞察力、与 HIV 相关的耻辱感、缺乏 HIV 相关知识、抗逆转录病毒副作用和延迟重新开始 ART。ART 依从性的促进因素包括从医院出院的动机、害怕生病、同伴支持、更长的住院时间、良好的医患关系、良好的饮食、隐私和保密性以及单一片剂疗法。医护人员描述了目前用于支持依从性的各种策略，包括直接观察治疗和家庭支持，并建议了一些潜在的方法来提高精神科住院患者对 ART 的依从性，包括使用注射用抗逆转录病毒药物和引入中途宿舍中心。这项研究的结果揭示了影响精神科住院患者 ART 依从性的众多因素的独特见解，并强调需要实施量身定制的策略来支持这一人群的 ART 依从性，他们的健康需求复杂。
