Bazrafshan Azam, Rafiei-Rad Ali Ahmad, Bazrafshan Maliheh Sadat, Ghalekhani Nima, Mehmandoost Soheil, SeyedAlinaghi SeyedAhmad, Mehrabi Fatemeh, Khezri Mehrdad, Mostashari Gelareh, Karamouzian Mohammad, Sharifi Hamid
HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Department of Sociology, Allameh Tabatabai University, Tehran, Iran.
Harm Reduct J. 2025 Jan 8;22(1):4. doi: 10.1186/s12954-024-01151-2.
Ensuring consistent adherence to antiretroviral therapy (ART) is crucial for effective HIV treatment and achieving viral suppression. Within prisons, the prevalence of HIV is notably high, and incarcerated individuals face an increased risk of transmitting the virus both during and after incarceration. However, facilitators and barriers to ART adherence among these individuals in low- and middle-income countries remain inadequately explored. This study applied the Social Ecological Model (SEM) to investigate how various individual, interpersonal, organizational, community and policy-level factors impact ART adherence among incarcerated populations in Iran during and post-incarceration.
This study employed a phenomenological qualitative approach using semi-structured interviews to gather insights. The research population consisted of people living with HIV (PLHIV) who had experienced incarceration and had been prescribed ART during their latest incarceration. Eleven PLHIV from two prisons located in Kerman and Tehran, Iran, formed the study group. Qualitative findings from the interviews were analyzed using a thematic approach. The findings were organized within the SEM framework to highlight key themes influencing ART adherence during and after incarceration.
Participants had an average age of 45.1 years (± 5.6). Various factors influence ART adherence during and post-incarceration. Participants highlighted the individual (e.g., HIV knowledge, previous treatment history, mental and physical health), interpersonal (e.g., family, friends, other incarcerated people, and prison health staff), organizational (e.g., ART treatment interventions, methadone maintenance therapy, and other health protocols), community (e.g., stigma, social isolation, discrimination and lack of access to community health services), and policy (e.g., financial interventions, and providing shelters) level factors influence ART adherence during and post-incarceration.
This study provides insights into the multi-level approach to ART adherence among PLHIV during and post-incarceration. It recommends implementing public health activities at the proposed multi-levels to maximize the synergies of intervention for the greatest impact.
确保持续坚持抗逆转录病毒疗法（ART）对于有效治疗艾滋病病毒（HIV）和实现病毒抑制至关重要。在监狱中，HIV的患病率显著较高，被监禁者在监禁期间及出狱后面临更高的病毒传播风险。然而，在低收入和中等收入国家，这些人群坚持ART的促进因素和障碍仍未得到充分探索。本研究应用社会生态模型（SEM）来调查各种个人、人际、组织、社区和政策层面的因素如何影响伊朗被监禁人群在监禁期间及出狱后对抗逆转录病毒疗法的坚持。
本研究采用现象学定性方法，通过半结构化访谈收集见解。研究人群包括曾被监禁且在最近一次监禁期间被开具ART处方的HIV感染者（PLHIV）。来自伊朗克尔曼和德黑兰两所监狱的11名PLHIV组成了研究组。访谈的定性结果采用主题分析法进行分析。研究结果在SEM框架内进行整理，以突出影响监禁期间及出狱后ART坚持的关键主题。
参与者的平均年龄为45.1岁（±5.6）。各种因素影响监禁期间及出狱后的ART坚持。参与者强调了个人（如HIV知识、既往治疗史、身心健康）、人际（如家人、朋友、其他被监禁者和监狱卫生工作人员）、组织（如ART治疗干预、美沙酮维持治疗和其他健康规程）、社区（如耻辱感、社会隔离、歧视以及无法获得社区卫生服务）和政策（如财政干预和提供庇护所）层面的因素影响监禁期间及出狱后的ART坚持。
本研究为PLHIV在监禁期间及出狱后坚持ART的多层次方法提供了见解。建议在提议的多层次开展公共卫生活动，以最大限度地发挥干预协同效应，产生最大影响。
