Clinical Epidemiology Unit, Makerere University, Kampala, Uganda.
Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda.
J Int Assoc Provid AIDS Care. 2024 Jan-Dec;23:23259582241236260. doi: 10.1177/23259582241236260.
Adherence to antiretroviral therapy (ART) is lower in adolescents with HIV (AWH) than in any other age group, partly due to self-regulatory challenges during development. Mindfulness and acceptance training have been shown to support psychological flexibility, a self-regulatory skill that potentially improves adolescent adherence to medication. We assessed the effect of weekly group-based mindfulness and acceptance training sessions on ART adherence among older adolescents (15-19 years) in Kampala, Uganda. One hundred and twenty-two AWH (median age 17, range 15-19 years, 57% female) receiving care at a public health facility in Kampala were randomized 1:1 to receive 4 weekly 90-min group sessions facilitated by experienced trainers or standard-of-care ART services. The training involved (Session 1) clarifying values, (Session 2) skillfully relating to thoughts, (Session 3) allowing and becoming aware of experiences non-judgmentally, and (Session 4) exploring life through trial and error. At baseline, postintervention, and 3-month follow-up, psychological flexibility was measured using the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8), and self-reported ART adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8). At baseline, the intervention and standard-of-care arms had similar psychological flexibility (AFQ-Y8 score:15.45 ± 0.82; 15.74 ± 0.84) and ART adherence (MMAS-8 score: 5.32 ± 0.24; 5.13 ± 0.23). Retention through the study was moderate (71%). Completion of mindfulness and acceptance training was associated with a significant reduction in psychological inflexibility at the 3-month follow-up (AFQ-Y8 score: 12.63 ± 1.06; 14.05 ± 1.07, = .006). However, no significant differences were observed in self-reported adherence to ART at the 3-month follow-up (MMAS-8 score: 5.43 ± 0.23; 4.90 ± 0.33, = .522). Group-based mindfulness and acceptance training improved psychological flexibility in this population of adolescents on ART in Uganda but did not significantly improve ART adherence. Future research should explore integrated approaches that combine behavioral management training with other empowerment aspects to improve ART adherence among AWH.
抗逆转录病毒疗法（ART）的依从性在感染艾滋病毒的青少年（AWH）中低于任何其他年龄组，部分原因是在发育过程中自我调节方面的挑战。正念和接纳训练已被证明支持心理灵活性，这是一种自我调节技能，可能会提高青少年对药物治疗的依从性。我们评估了每周小组正念和接纳训练对乌干达坎帕拉一家公共卫生机构接受治疗的大龄青少年（15-19 岁）ART 依从性的影响。122 名 AWH（中位年龄 17 岁，范围 15-19 岁，57%为女性）被随机分为 1:1 组，分别接受 4 周每周 90 分钟的小组课程，由经验丰富的培训师提供，或接受标准的 ART 服务。培训涉及（第 1 节课）澄清价值观，（第 2 节课）巧妙地与思想联系，（第 3 节课）不评判地允许和意识到经验，以及（第 4 节课）通过尝试和错误探索生活。在基线、干预后和 3 个月随访时，使用青少年回避和融合问卷（AFQ-Y8）测量心理灵活性，使用 Morisky 药物依从性量表（MMAS-8）评估自我报告的 ART 依从性。基线时，干预组和标准护理组的心理灵活性（AFQ-Y8 评分：15.45±0.82；15.74±0.84）和 ART 依从性（MMAS-8 评分：5.32±0.24；5.13±0.23）相似。研究期间的保留率为中等（71%）。完成正念和接纳训练与 3 个月随访时心理灵活性显著降低相关（AFQ-Y8 评分：12.63±1.06；14.05±1.07， = .006）。然而，在 3 个月随访时，自我报告的 ART 依从性没有显著差异（MMAS-8 评分：5.43±0.23；4.90±0.33， = .522）。小组正念和接纳训练提高了乌干达接受 ART 的青少年人群的心理灵活性，但并未显著提高 ART 依从性。未来的研究应探索将行为管理训练与其他赋权方面相结合的综合方法，以提高 AWH 的 ART 依从性。
