Mbarara University of Science and Technology, Departments of Pediatrics and Internal Medicine, Faculty of Medicine, Mbarara, Uganda.
Global Health Collaborative, Mbarara, Uganda.
AIDS Patient Care STDS. 2023 Oct;37(10):489-494. doi: 10.1089/apc.2023.0164.
Many adolescents and young adults with HIV (AYWH) struggle with antiretroviral therapy (ART) adherence and experience poorer outcomes than adults. Relevant factors include forgetfulness and poor self-efficacy related to their evolving neurobiology. We qualitatively explored experiences of AYWH-caregivers dyads using real-time ART adherence monitors and associated reminder functions in the home setting. As part of an implementation science-oriented study, AYWH used the Wisepill adherence monitor for 3 months. AYWH could also opt for short message service (SMS) self-reminders, a self-selected social supporter for delayed or missed doses, or an alarm reminder. We conducted in-depth interviews with randomly selected AYWH-caregiver dyads regarding their experience using the monitor. Qualitative data were analyzed using inductive content analysis. We completed 15 AYWH-caregiver dyad interviews. Of the AYWH, 67% were female, mean age was 16 years, 56% lived with their biological mother, and 86% were virologically suppressed. AYWH and their caregivers generally found the adherence monitors acceptable, though some had privacy concerns. AYWH felt the monitors helped them take charge of their medication, largely through the real-time alarm and SMS reminders; this took the burden of adherence reminders away from the caregivers, improving strained AYWH-caregiver relationships. Two adolescents reported rebound poor adherence after monitor withdrawal. ART adherence monitors and associated tools were largely acceptable to AYWH and their caregivers in home settings. The intervention helped improve AYWH self-efficacy and alleviated burden from some AYWH-caregiver relationships. Rebound poor adherence suggests the need for on-going support and/or other means to achieve intrinsic mechanisms for sustained adherence. Clinical Trial Registration number: NCT03825952.
许多感染艾滋病毒的青少年和年轻成年人（AYWH）在抗逆转录病毒治疗（ART）方面存在依从性问题，其治疗效果比成年人差。相关因素包括与不断发展的神经生物学相关的健忘和自我效能感差。我们使用实时 ART 依从性监测器和相关的家庭环境提醒功能，从定性的角度探索了 AYWH 护理者二人组的经验。作为以实施科学为导向的研究的一部分，AYWH 使用 Wisepill 依从性监测器 3 个月。AYWH 还可以选择短信（SMS）自我提醒、错过剂量时的自选社会支持者，或闹钟提醒。我们对随机选择的 AYWH-护理者二人组进行了深入访谈，了解他们使用监测器的经验。使用归纳内容分析法对定性数据进行分析。我们完成了 15 对 AYWH-护理者二人组的访谈。其中，67%的 AYWH 为女性，平均年龄为 16 岁，56%与亲生母亲生活在一起，86%病毒载量得到抑制。AYWH 和他们的照顾者通常认为依从性监测器是可以接受的，尽管有些人有隐私方面的担忧。AYWH 觉得监测器帮助他们负责自己的药物治疗，主要是通过实时警报和 SMS 提醒；这减轻了照顾者对药物治疗的提醒负担，改善了紧张的 AYWH-照顾者关系。两名青少年在停用监测器后报告出现反弹性依从性差的情况。在家庭环境中，ART 依从性监测器和相关工具对 AYWH 和他们的照顾者来说基本是可以接受的。该干预措施有助于提高 AYWH 的自我效能感，并减轻一些 AYWH-照顾者关系的负担。反弹性依从性差表明需要持续支持和/或其他方法来实现持续依从的内在机制。临床试验注册号：NCT03825952。
