Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
PLoS One. 2024 Jul 16;19(7):e0305918. doi: 10.1371/journal.pone.0305918. eCollection 2024.
We know that HIV treatment outcome depends on antiretroviral treatment (ART) adherence. Young adults with perinatal HIV (YPHIV) who survived have endured various adherence challenges in their adolescent years. While some of them could maintain perfect adherence with sustainable virologic suppression, many experienced one or more episodes of virologic failure. We explored factors affecting ART adherence from real-life experiences of YPHIV. A qualitative study was conducted between June and November 2022. Twenty YPHIV aged 21-29 years with a history of virologic failure and resumed virologic suppression during adolescent years were invited to share their experiences through individual in-depth interviews. Audio records were transcribed verbatim and analyzed using deductive thematic analysis. We divided excerpts into two themes: barriers and facilitators to ART adherence. The socio-ecological model was used to frame subthemes at personal, societal, and healthcare system levels. Most barriers to adherence were concentrated at the personal level, including work/study-related conditions, personal entertainment, medication issues, mental health problems, thought, and belief. At the societal level, social activities and fear of HIV disclosure were frequently mentioned as barriers. Medical care cost was the only identified barrier at the healthcare system level. The facilitators to adherence at the personal level included perceiving health deterioration, being afraid of hospitalization and medical procedures, and wishing to be healthy and move on. At the same time, perceived family support and determination to complete family without HIV transmission were identified as facilitators at the societal level. Service behaviors of healthcare providers were mentioned as facilitators to adherence at the healthcare system level. From this study, most factors associated with non-adherence in adolescents were at the personal level, and the fear of HIV disclosure was critical at the societal level. The key facilitator to adherence was the determination to be healthy and have a promising future. Our findings reinforce the importance of establishing youth-friendly services in the existing HIV care setting. More time allocation for tailored individual counseling, using other novel approaches like mHealth, online media, and involvement of social support from different sectors might be beneficial to maximize adherence self-efficacy during the transitional period of YPHIV.
我们知道，艾滋病毒治疗结果取决于抗逆转录病毒治疗（ART）的依从性。患有围生期艾滋病毒（YPHIV）并幸存下来的年轻成年人在青少年时期经历了各种依从性挑战。虽然他们中的一些人能够保持完美的依从性并实现持续的病毒学抑制，但许多人经历了一次或多次病毒学失败。我们从 YPHIV 的现实生活经验中探讨了影响 ART 依从性的因素。这项定性研究于 2022 年 6 月至 11 月进行。邀请了 20 名年龄在 21-29 岁之间、有过病毒学失败史并在青少年时期恢复病毒学抑制的 YPHIV 分享他们的经验，他们通过个人深入访谈分享了自己的经验。音频记录逐字转录，并使用演绎主题分析进行分析。我们将摘录分为两个主题：ART 依从性的障碍和促进因素。社会生态学模型用于在个人、社会和医疗保健系统层面构建子主题。大多数依从性障碍集中在个人层面，包括与工作/学习相关的条件、个人娱乐、药物问题、心理健康问题、思想和信仰。在社会层面，社会活动和对艾滋病毒披露的恐惧经常被提及为障碍。医疗保健费用是医疗保健系统层面唯一确定的障碍。个人层面上促进依从性的因素包括感知健康恶化、害怕住院和医疗程序，以及希望健康并继续前进。同时，在社会层面上，感知到家庭支持和完成没有艾滋病毒传播的家庭的决心被确定为促进因素。医疗保健提供者的服务行为被认为是医疗保健系统层面促进依从性的因素。从这项研究中可以看出，青少年中与不依从相关的大多数因素都在个人层面，对艾滋病毒披露的恐惧在社会层面至关重要。促进依从性的关键因素是健康和美好未来的决心。我们的研究结果强调了在现有的艾滋病毒护理环境中建立青年友好服务的重要性。为量身定制的个人咨询分配更多时间，使用 mHealth 等其他新方法、在线媒体以及调动不同部门的社会支持，可能有助于在 YPHIV 的过渡时期最大限度地提高依从性自我效能。
