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Rendell S, Schmidt H, Neergaard R, Nkwihoreze H, Barbati Z, Short WR, Rana AI, Sheth AN, Scott RK, Sethi S, Momplaisir FM. Integrating ART adherence support technologies in the care of pregnant and postpartum people with HIV: a qualitative study. Implement Sci Commun 2022; 3:85. [PMID: 35918738 PMCID: PMC9344442 DOI: 10.1186/s43058-022-00331-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background We have a limited understanding on how to best integrate technologies to support antiretroviral therapy (ART) adherence in routine HIV care. Methods We conducted semi-structured interviews with multidisciplinary providers caring for pregnant and postpartum people with HIV and asked providers about their perspectives on utilizing adherence support technologies such as text messages, video check-ins with providers or automated with facial recognition for directly-observed-therapy, signaling pill bottle, and signaling pill to support ART adherence. Each approach generated an adherence report. The interview instrument was guided by the Consolidated Framework for Implementation Research and included questions on the implementation climate, barriers, and facilitators to the clinical integration of the adherence approach and strategies that could be used to maximize this integration. The order of adherence support technologies was randomized to minimize bias. We used a modified grounded theory to develop the coding structure and two coders applied the codebook to the transcripts after establishing strong inter-rater reliability with 20% of interviews (kappa = 0.82). Results Between March and December 2020, we conducted 26 in-depth, semi-structured interviews with providers who weighed several factors when considering each approach, including the approach’s effect on patient-provider interaction in and outside of the clinic visit, timing for and duration of the approach’s utility, threat of disclosing status, and added burden to providers (e.g., needing to act on generated information) or to patients (e.g., needing to hide the signaling pills, responding to text messages). Providers’ most preferred approach was text-messages, and the least preferred was the signaling pill. Barriers to acceptability varied by approach and included perceived surveillance, violation of privacy, added time demand for providers, potential inaccuracy of the adherence data generated, and negative impact on the patient-provider relationship, particularly if the approach was perceived as coercive. Payers anticipated regulatory hurdles with unfamiliar approaches, particularly the signaling pill and signaling pill bottle. Facilitators included strengthened therapeutic alliance, predictable reminder mechanisms, and options for customization according to patient preference. Conclusions Our study elucidates barriers and facilitators to integrating technology-based adherence support approaches in clinical care to support adherence of pregnant and postpartum people with HIV.
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Acharya S, Parthasarathy M, Palkar A, Keskar P, Setia MS. Barriers for Antiretroviral Therapy Adherence and Viral Suppression in Members of the Key Population in Mumbai, India: Implications for Interventions. Indian J Dermatol 2021; 66:378-385. [PMID: 34759396 PMCID: PMC8530040 DOI: 10.4103/ijd.ijd_640_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Poor adherence to antiretroviral therapy (ART) is associated with poor virologic control and drug resistance in people living with HIV/AIDS. Some barriers to ART adherence are cost, lack of information, stigma, or dissatisfaction with health services. Aims and Objectives: To study the association between barriers for ART adherence and viral suppression, and explore the role of "missing ART dose" as a potential mediator in high-risk groups. Materials and Methods: Demographic, clinical, and behavioral data from 50 "virally suppressed" (viral load [VL] <1000 copies/ml) and 48 "not suppressed" (VL > 1000 copies/ml) individuals belonging to the key population in Mumbai were collected. Sociodemographic, behavioral, and other characteristics were compared, and mediation analysis was used to identify the mediator in the pathway to viral suppression. Results: Those who had missed their ART at least once in the past three months (37% versus 60%, P = 0.03) and stayed alone were less likely to be virally suppressed (31% versus 69%, P = 0.002). Individuals who had negative perception about ART (adjusted odds ratio [aOR]: 0.11, 95% confidence interval [CI]: 0.02, 0.47; P = 0.002), poor ART-related knowledge/behaviors (aOR: 0.14, 95% CI: 0.03, 0.60; P = 0.007), and poor pill taking practices (aOR: 0.10, 95% CI: 0.02, 0.61; P = 0.01) were significantly less likely to be virally suppressed. The mediation pathway "adherence theme > missed ART in the past three months > viral suppression" was significant in these themes. Conclusions: The factors associated with low viral suppression were knowledge/behaviors, perceptions about ART, and poor pill taking practices. Thus, it is important to provide correct information about ART, its effects, side effects, and potential limitations to marginalized population. Involving brothel keepers and Gurus (head of male-to-female transgendered people/Hijras clans), and technology enabled customized counseling sessions will be helpful.
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Affiliation(s)
- Shrikala Acharya
- Mumbai Districts AIDS Control Society, Mumbai, Maharashtra, India
| | | | - Amol Palkar
- Mumbai Districts AIDS Control Society, Mumbai, Maharashtra, India
| | - Padmaja Keskar
- Mumbai Districts AIDS Control Society, Mumbai, Maharashtra, India
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Pius A, Josephine NN, Erick S, Winifred A, Rita M, Silverjoseph O, Lucy E, Novatus N. Influence of intensified adherence counselling on viral load suppression of people receiving antiretroviral therapy at a health centre IV in southwestern Uganda: a qualitative study. AIDS Res Ther 2021; 18:45. [PMID: 34321025 PMCID: PMC8317373 DOI: 10.1186/s12981-021-00372-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 07/21/2021] [Indexed: 05/10/2023] Open
Abstract
Background The prevalence of Human Immunodeficiency Virus (HIV) among adults and children in Uganda is 6.2% and 0.5% respectively. The prevalence of viral load suppression in Uganda among all adults and children living with HIV is 59.6% and 39.3% respectively. High viral load compromises on the quality of life of an individual, and as well increases on the risk of transmission of the virus to the unborn for pregnant mothers and to the spouse. The UNAID 90-90-90 campaign recommends that 90% know their status, 90% get treatment and 90% have viral suppression. Non-adherence to Antiretroviral Therapy (ART) is one of the causes of the high viral load. The world health organization recommends Intensified Adherence Counselling (IAC) be given to all individuals with a high viral load. The perceptions, attitudes and practices of people receiving IAC is important in understanding how best IAC should be implemented. Methods A qualitative study was done among 30 purposively selected individuals/guardians of children receiving ART and IAC at Kyabugimbi Health Center Four [HC IV (mini-hospital headed by a medical doctor)]. Data collected from Focus Group Discussion as audio-recordings in local language (Runyankole) was transcribed and later translated into English. Translated transcripts were analyzed manually using thematic content analysis. Results The major themes identified include: adherence to ART; change of attitude towards ART after IAC, IAC expectation and outcomes, IAC and stigma, and improving social support through IAC for PLWHIV. Conclusion Participating in IAC to be informative and led to change in their perceptions of HIV and better understanding the reasons for adherence to ART. IAC influenced the change in attitude and behavior thus seeking social support and mitigate stigma, which lead to a better ART adherence. However, there is need to improve on the way it is delivered both in structural setting and break down and packaging of information.
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Rana U, Driedger M, Sereda P, Pan S, Ding E, Wong A, Walmsley S, Klein M, Kelly D, Loutfy M, Thomas R, Sanche S, Kroch A, Machouf N, Roy-Gagnon MH, Hogg R, Cooper CL. Clinical and demographic predictors of antiretroviral efficacy in HIV-HBV co-infected patients. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:137-148. [PMID: 36341035 PMCID: PMC9608701 DOI: 10.3138/jammi-2020-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/22/2020] [Indexed: 06/16/2023]
Abstract
BACKGROUND The clinical and demographic characteristics that predict antiretroviral efficacy among patients co-infected with HIV and hepatitis B virus (HBV) remain poorly defined. We evaluated HIV virological suppression and rebound in a cohort of HIV-HBV co-infected patients initiated on antiretroviral therapy. METHODS A retrospective cohort analysis was performed with Canadian Observation Cohort Collaboration data. Cox proportional hazards models were used to determine the factors associated with time to virological suppression and time to virological rebound. RESULTS HBV status was available for 2,419 participants. A total of 8% were HBV co-infected, of whom 95% achieved virological suppression. After virological suppression, 29% of HIV-HBV co-infected participants experienced HIV virological rebound. HBV co-infection itself did not predict virological suppression or rebound risk. The rate of virological suppression was lower among patients with a history of injection drug use or baseline CD4 cell counts of <199 cells per cubic millimetre. Low baseline HIV RNA and men-who-have-sex-with-men status were significantly associated with a higher rate of virological suppression. Injection drug use and non-White race predicted viral rebound. CONCLUSIONS HBV co-infected HIV patients achieve similar antiretroviral outcomes as those living with HIV mono-infection. Equitable treatment outcomes may be approached by targeting resources to key subpopulations living with HIV-HBV co-infection.
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Affiliation(s)
- Urvi Rana
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States
| | - Matt Driedger
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Sereda
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Shenyi Pan
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Erin Ding
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Alex Wong
- Regina Qu’Appelle Health Region, Regina, Saskatchewan, Canada
| | | | - Marina Klein
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Deborah Kelly
- Memorial University of Newfoundland, Saint John’s, Newfoundland, Canada
| | - Mona Loutfy
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Rejean Thomas
- Clinique Medicale l’Actuel, Montreal, Quebec, Canada
| | - Stephen Sanche
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Abigail Kroch
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Nima Machouf
- Clinique de Médicine Urbaine du Quartier Latin, Montreal, Quebec, Canada
| | | | - Robert Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Curtis L Cooper
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Acharya S, Palkar A, Keskar P, Setia MS. Factors associated with survival in adult people living with HIV/AIDS (PLHAs) in Mumbai, India (2004-2019): A retrospective cohort study. J Family Med Prim Care 2021; 10:758-764. [PMID: 34041073 PMCID: PMC8138381 DOI: 10.4103/jfmpc.jfmpc_1703_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/27/2020] [Accepted: 10/28/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Knowledge of factors that affect survival in People living with HIV/AIDS (PLHAs) on anti-retroviral therapy (ART) will help us develop and implement interventions to improve the clinical outcomes and survival in these individuals. The aim of this study was to estimate the survival in PLHAs on ART in the government ART programme in Mumbai, and the factors associated with survival in these individuals. Methods: It is a retrospective survival analysis of 28,345 adult PLHAs from 18 government ART centres in Mumbai (registration period 2004–2019). We estimated the mortality rates and their 95% confidence intervals [CIs], plotted the Kaplan Meier Survival curves, estimated incidence rate ratios (IRR) and hazard ratios (HR). There were done for the whole cohort and according to various demographic and clinical characteristics. Results: The mortality in PLHAs on ART was 9.04 per 1000 person years. The HR was significantly for those aged 50 years and more at the time of registration (HR: 3.01, 95% CI: 2.37, 3.83; P < 0.001), in those with baseline CD4 count of less than 200 higher hazard (HR: 1.83, 95% CI: 1.47, 2.27; P < 0.001), those with an adherence of 80–95% (HR; 5.58, 95% CI: 4.61, 6.75; P < 0.001) and adherence of <80% (HR: 9.37, 95% CI: 7.74, 11.33; P < 0.001). Furthermore, the hazard was significantly higher in those with TB compared those without TB (HR: 3.28, 95% CI: 2.87, 3.75; P < 0.001). Time from diagnosis (per month increase) to initiation of ART was not significantly associated with mortality. Conclusions: Increasing awareness about HIV testing and early detection of HIV in those who have high-risk behaviours, prompt diagnosis and management of TB among those infected, and developing and implementing strategies (such as enhanced counselling, telephone-based applications, messages, or reminders) to ensure ART adherence of more than 95% in those on ART will potentially help improve survival in PLHAs in India.
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Affiliation(s)
- Shrikala Acharya
- Additional Project Director, Mumbai Districts AIDS Control Society, Mumbai, India
| | - Amol Palkar
- Data Specialist, Mumbai Districts AIDS Control Society, Mumbai, India
| | - Padmaja Keskar
- Project Director, Mumbai Districts AIDS Control Society, Mumbai, India
| | - Maninder Singh Setia
- Consultant Dermatologist and Epidemiologist, Department of Dermatology, Mumbai, India
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Konstantinou P, Kassianos AP, Georgiou G, Panayides A, Papageorgiou A, Almas I, Wozniak G, Karekla M. Barriers, facilitators, and interventions for medication adherence across chronic conditions with the highest non-adherence rates: a scoping review with recommendations for intervention development. Transl Behav Med 2020; 10:1390-1398. [PMID: 33231691 DOI: 10.1093/tbm/ibaa118] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Medication non-adherence (MNA) constitutes a complex health problem contributing to increased economic burden and poor health outcomes. The Medication Adherence Model (MAM) supports that numerous processes are involved in medication adherence (MA). Based on the MAM and guidelines of the World Health Organization (WHO), this scoping review aimed to identify the barriers and facilitators associated with MA, and the behavioral health interventions and techniques among chronic conditions presenting with high non-adherence rates (asthma, cancer, diabetes, epilepsy, HIV/AIDS, and hypertension). PubMed, PsycINFO, and Scopus databases were screened, and 243 studies were included. A mixed methods approach was used to collate the evidence and interpret findings. The most commonly reported barriers to MA across conditions were younger age, low education, low income, high medication cost, side effects, patient beliefs/perceptions, comorbidities, and poor patient-provider communication. Additionally, digitally delivered interventions including components such as medication and condition education, motivational interviewing (MI), and reinforcement and motivational messages led to improvements in MA. This review highlights the importance of administrating multicomponent interventions digitally and personalized to the patients' individual needs and characteristics, responding to the adherence barriers faced. This is the first review examining and synthesizing evidence on barriers and facilitators to MA and behavioral health interventions used for improving MA across chronic conditions with the highest non-adherence rates and providing recommendations to researchers and clinicians. Stakeholders are called to explore methods overcoming barriers identified and developing effective multicomponent interventions that can reduce the high rates of MNA.
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Affiliation(s)
| | - Angelos P Kassianos
- Department of Psychology, University of Cyprus, Nicosia, Cyprus.,Department of Applied Health Research, UCL, London
| | - Giοrgos Georgiou
- Department of Social and Behavioral Sciences, European University Cyprus, Nicosia, Cyprus
| | - Andreas Panayides
- 3AE Health LTD, Nicosia, Cyprus.,Department of Computer Science, University of Cyprus, Nicosia, Cyprus
| | | | - Ioannis Almas
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | - Greta Wozniak
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | - Maria Karekla
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
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Anyaike C, Atoyebi OA, Musa OI, Bolarinwa OA, Durowade KA, Ogundiran A, Babatunde OA. Adherence to combined Antiretroviral therapy (cART) among people living with HIV/AIDS in a Tertiary Hospital in Ilorin, Nigeria. Pan Afr Med J 2019; 32:10. [PMID: 31080546 PMCID: PMC6497984 DOI: 10.11604/pamj.2019.32.10.7508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 12/19/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction This study aims to assess the treatment adherence rate among People Living With HIV/AIDS (PLWHA) receiving treatment in a Nigerian tertiary Hospital. Methods This was a cross-sectional study that assessed self-reported treatment adherence among adults aged 18 years and above who were accessing drugs for the treatment of HIV. Systematic random sampling method was used to select 550 participants and data were collected by structured interviewer administered questionnaire. Results The mean age of respondents was 39.9±10 years. Adherence rate for HIV patients was 92.6%. Factors affecting adherence include lack of money for transportation to the hospital (75%), traveling (68.8%), forgetting (66.7%), avoiding side effects (66.7%), and avoiding being seen (63.6%). Conclusion The adherence rate was less than optimal despite advancements in treatment programmes. Adherence monitoring plans such as home visit and care should be sustained.
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Affiliation(s)
- Chukwuma Anyaike
- National AIDS/STIs Control Programme, Federal Ministry of Health, Abuja, Nigeria.,Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Omotoso Ibrahim Musa
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Oladimeji Akeem Bolarinwa
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Kabir Adekunle Durowade
- Department of Community Medicine, Federal Teaching Hospital, PMB 201, Ido-Ekiti, Nigeria.,Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
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Abstract
Importance There are approximately 284,500 adolescent and adult women living with human immunodeficiency virus (HIV) in the United States. It is estimated that approximately 8500 of these women give birth annually. While the rate of perinatal transmission in the United States has decreased by more than 90% since the early 1990s, potentially preventable HIV transmission events still occur and cause significant morbidity and mortality. Objective The aim of this review was to summarize the current data regarding perinatal HIV transmission timing and risk factors, current management recommendations, and implications of timing of transmission on patient management. Evidence Acquisition Literature review. Results This review reiterates that the risk of perinatal HIV transmission can be reduced to very low levels by following current recommendations for screening for HIV in all pregnant women and properly treating HIV-infected mothers, as well as using evidence-based labor management practices. Conclusions and Relevance Familiarity with the pathogenesis of HIV transmission is important for obstetric care providers to appropriately manage HIV-infected women in pregnancy, intrapartum, and the postpartum period.
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Metacognitive Interpersonal Therapy Improves Adherence to Antiretroviral Therapies in a Man with a Severe Personality Disorder: A Case Report. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2017. [DOI: 10.1007/s10879-017-9363-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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How are women living with HIV in France coping with their perceived side effects of antiretroviral therapy? Results from the EVE study. PLoS One 2017; 12:e0173338. [PMID: 28264016 PMCID: PMC5338806 DOI: 10.1371/journal.pone.0173338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/20/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Side effects of antiretroviral therapy (ART) can have a negative impact on health-related quality of life threatening long-term retention in HIV care and adherence to ART. The aim of the French community-based survey EVE was to document personal experiences with side effects, the related physician-patient communication, and solutions found to deal with them. DESIGN Cross-sectional study of women between September 2013 to September 2014. METHODS An anonymous online questionnaire included the HIV Symptom Distress Module, which explores 20 symptoms. RESULTS In all, 301 women on ART participated in the study (median age: 49 years; median duration of ART: 14 years). They reported having experienced a median of 12 symptoms (Q1-Q3: 9-15) during the previous 12 months. Overall, 56% of them reported having found at least a partial solution to dealing with their symptoms. Women reporting financial difficulties were twice less likely to have found solutions to coping with their side effects (AOR: 0.5; 95% CI: 0.3-0.8). Feeling supported by the health-care provider (AOR: 2.1; 95% CI: 1.1-3.9) and being in contact with HIV/AIDS organisations (AOR: 1.9; 95% CI: 1.2-3.2) were positively associated with coping. Seventeen percent reported having modified their ART regimen to improve tolerance, with only 2 in 3 informing their physician afterwards. Reporting financial difficulties and living with more bothersome symptoms increased the risk of ART regimen modification without health-care provider consultation. CONCLUSION The EVE study has called attention to the large number of side effects experienced by WLWHIV, only half of whom have found self-care strategies to manage their symptoms. Modification of ART regimen by the women themselves was not uncommon.
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11
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Li H, Marley G, Ma W, Wei C, Lackey M, Ma Q, Renaud F, Vitoria M, Beanland R, Doherty M, Tucker JD. The Role of ARV Associated Adverse Drug Reactions in Influencing Adherence Among HIV-Infected Individuals: A Systematic Review and Qualitative Meta-Synthesis. AIDS Behav 2017; 21:341-351. [PMID: 27613645 PMCID: PMC5290204 DOI: 10.1007/s10461-016-1545-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Poor adherence remains a major barrier to achieving the clinical and public health benefits of antiretroviral drugs (ARVs). A systematic review and qualitative meta-synthesis was conduct to evaluate how ARV adverse drug reactions may influence ARV adherence. Thirty-nine articles were identified, and 33 reported that ARV adverse drug reactions decreased adherence and six studies found no influence. Visually noticeable adverse drug reactions and psychological adverse reactions were reported as more likely to cause non-adherence compared to other adverse drug reactions. Six studies reported a range of adverse reactions associated with EFV-containing regimens contributing to decreased adherence. Informing HIV-infected individuals about ARV adverse drug reactions prior to initiation, counselling about coping mechanisms, and experiencing the effectiveness of ARVs on wellbeing may improve ARV adherence.
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Affiliation(s)
- Haochu Li
- School of Public Health, Shandong University, Jinan, China.
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Gifty Marley
- School of Public Health, Shandong University, Jinan, China
| | - Wei Ma
- School of Public Health, Shandong University, Jinan, China
| | - Chongyi Wei
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Mellanye Lackey
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Qingyan Ma
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Marco Vitoria
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Rachel Beanland
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Joseph D Tucker
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- UNC Project-China, Guangdong Provincial Skin Diseases and STI Control, Number 2 Lujing Road, Guangzhou, 510095, China.
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12
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McDougall GJ, Dalmida SG, Foster PP, Burrage J. Barriers and Facilitators to HIV Testing Among Women. HIV/AIDS RESEARCH AND TREATMENT : OPEN JOURNAL 2016; 2016:S9-S13. [PMID: 29607406 PMCID: PMC5875928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM The purpose of this secondary analysis was to analyze for barriers and facilitators to HIV testing in women attending community health clinics. INTRODUCTION The Centers for Disease Control and Prevention (CDC), reported that all women account for 20% or 1 in 5 of new HIV cases (CDC, 2012). Of those new cases in heterosexual women, 5,300 were Black, 1,300 were White, and 1,200 were Hispanic/Latina. The CDC estimated that in 2012 there were 9,268 individuals living with a diagnosis of HIV or AIDS, of which 19% were women. RESULTS The existing de-identified data consisted of thirty individual interviews conducted using a semi-structured interview guide was collected as the initial phase of the parent study, "HIV Testing and Women's Attitudes on HIV Vaccine Trials". This secondary analysis addressed the identification of key obstacles to HIV testing and only those related portions of the transcripts were analyzed. The major themes identified were familiarity with testing, stigma, fear, perceived risks, and access to care. CONCLUSION The themes implicated the need to further assess women for barriers and facilitators to testing, tailor community based interventions that have the ability to decrease fear and stigma, increase trust in testing methods and offer counseling to positive results.
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Affiliation(s)
- Graham J. McDougall
- Capstone College of Nursing, University of Alabama Capstone College of Nursing, Tuscaloosa, AL 35487, USA
| | - Safiya George Dalmida
- Capstone College of Nursing, University of Alabama Capstone College of Nursing, Tuscaloosa, AL 35487, USA
| | - Pamela Payne Foster
- Institute for Rural Health Research, College of Community Health Sciences, The University of Alabama, Tuscaloosa, AL 35487, USA
| | - Joe Burrage
- Graduate Programs and Associate Professor at The University of Alabama Capstone College of Nursing, Tuscaloosa, AL, USA
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Abstract
Medication noncompliance is a pervasive problem resulting in significant morbidity and mortality. There are many terms used to describe medication-taking behavior including compliance, adherence, intelligent compliance, and drug forgiveness. More recently, clinicians have focused on the need for a collaborative partnership with patients to attain medication adherence. Problems identified include the patient’s failing to initiate therapy, under using or overusing a drug, stopping a drug too soon, and mistiming or skipping doses. Adherence to medications is a complex health behavior. There are many risk factors associated with decreased compliance, and many strategies have been shown to improve drug-taking behavior and patient outcomes. By careful assessment, the pharmacist can identify the high-risk patient, recommend an individualized care plan, and provide the follow-up necessary to successfully change patient behavior. Pharmacists should focus on improving their own application of behavior modification principles and patient communication skills. Improved medication compliance results in improved humanistic, clinical, and economic outcomes.
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Affiliation(s)
- Patricia A. Tabor
- Blackstock Family Practice Academic Associates, University of Texas at Austin, Pharmacy Practice Division, One University Station A1910, Austin, TX 78712-0127,
| | - Debra A. Lopez
- Scott & White Hospital, Health Plan, and Clinic, University of Texas College of Pharmacy, Scott & White Clinic, 4945 Williams Drive, Georgetown, TX 78628
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14
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Archiopoli A, Ginossar T, Wilcox B, Avila M, Hill R, Oetzel J. Factors of interpersonal communication and behavioral health on medication self-efficacy and medication adherence. AIDS Care 2016; 28:1607-1614. [PMID: 27320778 DOI: 10.1080/09540121.2016.1192577] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Despite devastating effects on health outcomes and disease progression, many people living with HIV (PLWH) are non-adherent to their medications. Medication self-efficacy is a pivotal factor in medication adherence, yet its formation and relationship with other factors are understudied. This study examines a model that considers the role of three communicative factors (patient-provider communication, social support, and social undermining) and two behavioral health factors (depression and alcohol abuse) and medication self-efficacy impacting medication adherence. Methods included a cross-sectional design using a survey questionnaire of 344 PLWH. Findings indicated that 25% of variance in medication adherence can be explained by a mediation model where depression (B = -.18) and provider-patient communication (B = .21) affect medication self-efficacy, which in turn impacts medication adherence (B = .64). Other variables, including demographics, did not add any explanatory power. These findings demonstrate the complex nature of medication adherence and the formation of medication self-efficacy.
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Affiliation(s)
- Ashley Archiopoli
- a Department of Arts & Humanities , University of Houston-Downtown , Houston , TX , USA
| | - Tamar Ginossar
- b Department of Communication & Journalism , The University of New Mexico , Albuquerque , NM , USA
| | - Bryan Wilcox
- c Department of Political Science , University of California , Los Angeles , CA , USA
| | - Magdalena Avila
- d Department of Health, Exercise and Sports Science , The University of New Mexico , Albuquerque , NM , USA
| | - Ricky Hill
- e Department of Medicine , University of Chicago , Chicago , IL , USA
| | - John Oetzel
- f Department of Management Communication , University of Waikato , Hamilton , New Zealand
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Yoo-Jeong M, Waldrop-Valverde D, McCoy K, Ownby RL. A Structural Equation Model of HIV-related Symptoms, Depressive Symptoms, and Medication Adherence. ACTA ACUST UNITED AC 2016; 2. [PMID: 27695710 DOI: 10.16966/2380-5536.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Adherence to combined antiretroviral therapy (cART) remains critical in management of HIV infection. This study evaluated depression as a potential mechanism by which HIV-related symptoms affect medication adherence and explored if particular clusters of HIV symptoms are susceptible to this mechanism. Baseline data from a multi-visit intervention study were analyzed among 124 persons living with HIV (PLWH). A bifactor model showed two clusters of HIV-related symptom distress: general HIV-related symptoms and gastrointestinal (GI) symptoms. Structural equation modeling showed that both general HIV-related symptoms and GI symptoms were related to higher levels of depressive symptoms, and higher levels of depressive symptoms were related to lower levels of medication adherence. Although general HIV-related symptoms and GI symptoms were not directly related to adherence, they were indirectly associated with adherence via depression. The findings highlight the importance of early recognition and evaluation of symptoms of depression, as well as the underlying physical symptoms that might cause depression, to improve medication adherence.
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Affiliation(s)
- Moka Yoo-Jeong
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Drenna Waldrop-Valverde
- Center for Neurocognitive Studies, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Katryna McCoy
- School of Nursing & Health Studies, University of Washington Bothell, Bothell, Washington, USA
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Varela Arevalo MT, Hoyos Hernandez PA. La adherencia al tratamiento para el VIH/SIDA: más allá de la toma de antirretrovirales. Rev Salud Publica (Bogota) 2015; 17:528-540. [DOI: 10.15446/rsap.v17n4.38429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 01/09/2015] [Indexed: 11/09/2022] Open
Abstract
<p><strong>Objetivo</strong> Describir la adherencia a aspectos no-farmacológicos del tratamiento en personas con VIH/Sida de la ciudad de Cali, Colombia y establecer su relación con aspectos socio-demográficos.</p><p><strong>Material y Métodos</strong> Estudio observacional transversal, con una muestra de 277 personas con VIH/Sida de nueve instituciones de salud. Se utilizó el cuestionario de adherencia al tratamiento para el VIH/Sida.</p><p><strong>Resultados</strong> Sólo el 37 % de las personas son adherentes al tratamiento no-farmacológico. El análisis de los factores socio-demográficos relacionados con la adherencia, muestra que tienen menor oportunidad de estar adheridos los menores de 40 años.</p><p><strong>Conclusiones</strong> La adherencia al tratamiento no-farmacológica es baja y parece ser un problema generalizado en la población con VIH/Sida, si bien es más grave en menores de 40 años. Los resultados muestran que es necesario realizar intervenciones que mejoren la adherencia no-farmacológica para contribuir al control de la infección, y que éstas deben implementarse en todas las personas diagnosticadas, con especial énfasis en la población joven.</p>
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Orchard T, Salters K, Michelow W, Lepik K, Palmer A, Hogg R. “My job is to deal with what I can”: HIV care providers’ perspectives on adherence to HAART, addictions, and comprehensive care delivery in Vancouver, British Columbia. CRITICAL PUBLIC HEALTH 2015. [DOI: 10.1080/09581596.2015.1088641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Ho SS, Holloway A. The impact of HIV-related stigma on the lives of HIV-positive women: an integrated literature review. J Clin Nurs 2015; 25:8-19. [PMID: 26234952 DOI: 10.1111/jocn.12938] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To critically explore how Human Immunodeficiency Virus-related stigma impacts on the lives of Human Immunodeficiency Virus-positive women through an integrative review of the literature. BACKGROUND Throughout history Human Immunodeficiency Virus infection has been associated with sex trade, injecting drug use and other deviant behaviours within society. These historical associations can lead to the generation of negative perceptions of Human Immunodeficiency Virus-positive women. As such, women who contract Human Immunodeficiency Virus infection can be susceptible to societal stigma. DESIGN An integrative literature review. METHODS To identify the publications on the impact of Human Immunodeficiency Virus-related stigma among women, a search was performed using the following databases: CINAHL, Medline, PsycINFO, EMBASE, and Applied Social Sciences Index and Abstract covering the period from 2000-2014. The following key words were included in the search: 'women', 'Human Immunodeficiency Virus', and 'stigma'. RESULTS Twenty-six articles were retrieved and reviewed. From the results, four key themes merged in relation to the impact of Human Immunodeficiency Virus-related stigma on Human Immunodeficiency Virus-positive women's lives: the individual, relationships, work and the community. CONCLUSIONS Despite great advances in the management and treatment of those who are Human Immunodeficiency Virus positive, it appears the lives of many women living with Human Immunodeficiency Virus remain greatly affected by their Human Immunodeficiency Virus infection with gender-specific stigma and stereotypes. Having a holistic understanding of this impact offers the potential for those responsible for the funding and draws the attention of researchers and policy makers on promoting medical services specifically for Human Immunodeficiency Virus-positive women, minimising social stigmatisation towards this client group, and optimising their health outcomes. RELEVANCE TO CLINICAL PRACTICE In an attempt to amplify Human Immunodeficiency Virus-positive women's ability to resist social injustice, obtain support and optimise their health outcomes, nurses should expand their roles and work with professionals from different sectors to ensure the provision of comprehensive care to women with Human Immunodeficiency Virus infection.
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Affiliation(s)
- Szu-Szu Ho
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Aisha Holloway
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
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19
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Fagbami O, Oluwasanjo A, Fitzpatrick C, Fairchild R, Shin A, Donato A. Factors Supporting and Inhibiting Adherence to HIV Medication Regimen in Women: A Qualitative Analysis of Patient Interviews. Open AIDS J 2015; 9:45-50. [PMID: 26157537 PMCID: PMC4483537 DOI: 10.2174/1874613601509010045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/30/2015] [Accepted: 04/02/2015] [Indexed: 11/22/2022] Open
Abstract
Adherence to antiretroviral therapy reduces morbidity and mortality; however rates of non-adherence are variable among women for unclear reasons. This study was a single-center qualitative analysis of interviews with 18 female HIV-positive non-adherent patients (defined by virologic failure) to explore psychosocial factors impacting adherence. Factors identified were categorized as promoting, inhibiting or having no effect on adherence. Three themes, characterized as social factors, illness factors and other societal pressures, were identified. Medical systems support, family support and compliance for children were most commonly identified as promoting adherence, while psychiatric comorbidities, lack of medical systems support and side effects were identified most often as inhibitors of adherence. While stigma was frequently identified, it was not seen as a barrier to adherence. Enhancing relationships between patients and their providers as well as their community support systems are critical avenues to pursue in improving compliance. Interventions to promote compliance are important avenues of future research.
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Affiliation(s)
- Oluwakemi Fagbami
- Reading Health System, 6th Avenue and Spruce Street, West Reading, Pennsylvania, 19611, USA
| | - Adetokunbo Oluwasanjo
- Reading Health System, 6th Avenue and Spruce Street, West Reading, Pennsylvania, 19611, USA
| | | | - Rebecca Fairchild
- Reading Health System, 6th Avenue and Spruce Street, West Reading, Pennsylvania, 19611, USA
| | - Ann Shin
- Reading Health System, 6th Avenue and Spruce Street, West Reading, Pennsylvania, 19611, USA
| | - Anthony Donato
- Reading Health System, 6th Avenue and Spruce Street, West Reading, Pennsylvania, 19611, USA
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20
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Baker JL, Rodgers CRR, Davis ZM, Gracely E, Bowleg L. Results from a secondary data analysis regarding satisfaction with health care among African American women living with HIV/AIDS. J Obstet Gynecol Neonatal Nurs 2014; 43:664-676. [PMID: 25139373 DOI: 10.1111/1552-6909.12491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To analyze satisfaction with health care among African American women living with HIV/AIDS. DESIGN Secondary analysis of baseline data of African American women who participated in Protect and Respect, a sexual risk reduction program for women living with HIV/AIDS SETTING: HIV Care Clinic in an urban city in the northeast United States. PARTICIPANTS One hundred fifty-seven (157) African American women living with HIV/AIDS. METHODS Regression analyses were used to examine the relationships between demographic variables, self-reported health characteristics, communication with health care providers, and satisfaction with health care provider. RESULTS A majority of women reported satisfaction with medical services (88%, n = 140). Communication with health care providers, detectable viral load, education, income, self-reported health status, and sexual orientation were significantly bivariately associated with satisfaction with healthcare (all ps < .05). In the multivariate models, no variables significantly predicted satisfaction with healthcare. CONCLUSION Because satisfaction with health care can influence the quality of care received, health outcomes, and adherence to provider recommendations among patients living with HIV/AIDS, health care providers' ability to elicit satisfaction from their patients is just as important as the services they provide. This project is one of the first studies to find high rates of satisfaction with health care among African American women living with HIV/AIDS. Further examination of satisfaction with health care among African American women living HIV/AIDS may help in narrowing health care disparities and negative treatment outcomes.
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21
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Wendorf AR, Mosack KE. Navigating hazardous conditions: understanding HIV medication adherence in the context of depression. QUALITATIVE HEALTH RESEARCH 2013; 23:541-554. [PMID: 23221125 DOI: 10.1177/1049732312469462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Depression is highly prevalent among HIV-positive individuals and has been identified as an important predictor of suboptimal adherence to highly active antiretroviral treatment (HAART). To date, however, researchers have not adequately examined how depression influences adherence among depressed HIV-positive patients. The aim of our study was to explore the process by which depression interacts with other factors relevant to medication adherence decision making to influence adherence to HAART. We used principles of grounded theory to guide our methods. We conducted interviews with 21 HIV-positive individuals diagnosed with comorbid depressive disorders. Results indicated that depression, HIV-related cues, and health and self-care beliefs combined to influence coping strategies. Coping strategies, in turn, predicted whether participants were able to adhere to HAART. These findings can be used by practitioners to broaden the scope of factors they consider when treating depressed patients who might be at risk for nonadherence.
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Affiliation(s)
- Angela R Wendorf
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53201, USA.
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22
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Bankoff SM, McCullough MB, Pantalone DW. Patient-provider relationship predicts mental and physical health indicators for HIV-positive men who have sex with men. J Health Psychol 2013; 18:762-72. [PMID: 23449678 DOI: 10.1177/1359105313475896] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We used secondary data analysis to examine associations among aspects of patient-provider relationships and mental and physical health indicators. Positive patient perceptions of patient-provider relationships were associated with fewer mental health symptoms in this outpatient sample of HIV-positive men who have sex with men (N = 171). Regression analyses revealed the role of anxiety and depression in explaining associations between two aspects of patient-provider relationships (i.e. quality of information offered and provider interactional style) and health-related quality of life. The findings demonstrated the importance of patient-provider relationships to improving physical health and functioning and maintaining engagement in care, among HIV-positive men who have sex with men.
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Affiliation(s)
- Sarah M Bankoff
- Department of Psychology, Suffolk University, 41 Temple Street, Boston, MA 02114, USA.
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23
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Heinrich C, Kuiper RA. Using Handheld Devices to Promote Medication Adherence in Chronic Illness. J Nurse Pract 2012. [DOI: 10.1016/j.nurpra.2011.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Li L, Ji G, Ding Y, Tian J, Lee A. Perceived burden in adherence of antiretroviral treatment in rural China. AIDS Care 2011; 24:502-8. [PMID: 22084972 DOI: 10.1080/09540121.2011.613912] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
To determine the level of antiretroviral treatment adherence and explore the correlated factors of perceived burden of taking antiretroviral medications among people living with HIV (PLH) in a rural area of China. Data were collected from 66 PLH who were currently receiving antiretroviral treatment. Face-to-face interviews were conducted during August to October, 2009. Approximately 18.2% of participants failed to adhere to antiretroviral treatment in the previous 30 days. A majority of PLH reported that taking antiretroviral medications posed a burden to them. Those who perceived a higher level of burden were more likely to be women, to have lower annual income, and to report a high level of depressive symptoms, poor physical health, and strained family interactions. Findings suggest that future programs in promoting adherence to antiretroviral treatment should address issues related to psychosocial well-being and PLH's interactions with their family members.
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Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, USA.
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25
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Determinants of optimal adherence over time to antiretroviral therapy amongst HIV positive adults in South Africa: a longitudinal study. AIDS Behav 2011; 15:1465-74. [PMID: 20352319 DOI: 10.1007/s10461-010-9688-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Highly active antiretroviral therapy (HAART) requires strict adherence to achieve optimal clinical and survival benefits. A study was done to explore the factors affecting HAART adherence among HIV positive adults by reviewing routinely collected patient information in the Centre for the AIDS Programme of Research in South Africa's (CAPRISA) AIDS Treatment Programme. Records of 688 patients enrolled between 2004 and 2006 were analysed. Patients were considered adherent if they had taken at least 95% of their prescribed drugs. Generalized estimating equations were used to analyse the data. The results showed that HAART adherence increased over time, however, the rate of increase differed by some of the socio-demographic and behavioural characteristics of the patients. For instance, HAART adherence increased in both urban and rural treatment sites over time, but the rate of increase was higher in the rural site. This helped identify sub-populations, such as the urban population, that required ongoing adherence counseling.
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26
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DiStefano AS, Cayetano RT. Health care and social service providers' observations on the intersection of HIV/AIDS and violence among their clients and patients. QUALITATIVE HEALTH RESEARCH 2011; 21:884-899. [PMID: 21441414 DOI: 10.1177/1049732311403501] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Associations between HIV/AIDS and several forms of violence have been demonstrated in recent research. We conducted qualitative interviews with 30 providers who offered services related to HIV/AIDS or violence to identify specific manifestations of HIV/AIDS-violence intersections, factors that explain why HIV/AIDS and violence intersect in client/patient populations, and the theoretical salience of providers' narratives. Providers confirmed links between HIV/AIDS and violent victimization, and yielded new insights into crossover risk between HIV/AIDS and suicidality, nonsuicidal self-harm, and witnessing and perpetrating violence. We also isolated 20 explanatory factors, including substance use, poor mental health, sex work/trading sex, and sexual orientation/gender identity. Narratives were consistent with syndemics theory, indicating that HIV/AIDS and violence fueled each other's occurrence and magnified the health-related burden on affected client/patient populations, often under conditions of health and social disparity. Providers contribute a novel perspective on our understanding of HIV/AIDS-violence syndemics that shows promise in informing future interventions and practice.
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Affiliation(s)
- Anthony S DiStefano
- California State University, Fullerton, Department of Health Science, P.O. Box 6870, Fullerton, CA 92834-6870, USA.
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27
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Wagner GJ, Bogart LM, Galvan FH, Banks D, Klein DJ. Discrimination as a key mediator of the relationship between posttraumatic stress and HIV treatment adherence among African American men. J Behav Med 2011; 35:8-18. [PMID: 21318411 DOI: 10.1007/s10865-011-9320-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 01/24/2011] [Indexed: 11/24/2022]
Abstract
Posttraumatic stress disorder (PTSD) is relatively common among people living with HIV/AIDS (PLHA) and may be associated with antiretroviral therapy (ART) adherence. We examined the relationship between PTSD symptom severity and adherence among 214 African American males. Because PLHA may experience discrimination, potentially in the form of traumatic stress (e.g., hate crimes), we also examined whether perceived discrimination (related to race, HIV status, sexual orientation) is an explanatory variable in the relationship between PTSD and adherence. Adherence, monitored electronically over 6 months, was negatively correlated with PTSD total and re-experiencing symptom severity; all 3 discrimination types were positively correlated with PTSD symptoms and negatively correlated with adherence. Each discrimination type separately mediated the relationship between PTSD and adherence; when both PTSD and discrimination were included in the model, discrimination was the sole predictor of adherence. Findings highlight the critical role that discrimination plays in adherence among African American men experiencing posttraumatic stress.
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Crandell JL, Voils CI, Chang Y, Sandelowski M. Bayesian data augmentation methods for the synthesis of qualitative and quantitative research findings. ACTA ACUST UNITED AC 2010; 45:653-669. [PMID: 21572970 DOI: 10.1007/s11135-010-9375-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The possible utility of Bayesian methods for the synthesis of qualitative and quantitative research has been repeatedly suggested but insufficiently investigated. In this project, we developed and used a Bayesian method for synthesis, with the goal of identifying factors that influence adherence to HIV medication regimens. We investigated the effect of 10 factors on adherence. Recognizing that not all factors were examined in all studies, we considered standard methods for dealing with missing data and chose a Bayesian data augmentation method. We were able to summarize, rank, and compare the effects of each of the 10 factors on medication adherence. This is a promising methodological development in the synthesis of qualitative and quantitative research.
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Affiliation(s)
- Jamie L Crandell
- Department of Biostatistics, University of North Carolina at Chapel Hill, #7460 Carrington Hall, Chapel Hill, NC 27599, USA; School of Nursing, University of North Carolina at Chapel Hill, #7460 Carrington Hall, Chapel Hill, NC 27599, USA
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29
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Maqutu D, Zewotir T, North D, Naidoo K, Grobler A. Factors affecting first-month adherence to antiretroviral therapy among HIV-positive adults in South Africa. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2010; 9:117-124. [PMID: 21779200 DOI: 10.2989/16085906.2010.517478] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This study explores the influence of baseline factors on first-month adherence to highly active antiretroviral therapy (HAART) among adults. The study design involved a review of routinely collected patient information in the CAPRISA AIDS Treatment (CAT) programme, at a rural and an urban clinic in KwaZulu-Natal Province, South Africa. The records of 688 patients enrolled in the CAT programme between June 2004 and September 2006 were analysed. Adherence was calculated from pharmacy records (pill counts) and patients were considered adherent if they had taken at least 95% of their prescribed drugs. Logistic regression was used to analyse the data and account for confounding factors. During the first month of therapy, 79% of the patients were adherent to HAART. HAART adherence was negatively associated with a higher baseline CD4 count. Women had better adherence if they attended voluntarily testing and counselling or if they had taken an HIV test because they were unwell, while men had higher adherence if they were tested due to perceived risk of HIV infection. HAART adherence was positively associated with higher age among patients who possessed cell phones and among patients who provided a source of income in the urban setting, but not in the rural setting. Though long-term data from this cohort is required to fully evaluate the impact of non-adherence in the first month of treatment, this study identifies specific groups of patients at higher risk for whom adherence counselling should be targeted and tailored. For example, first-month HAART adherence can be improved by targeting patients initiated on treatment with a high CD4 count.
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Affiliation(s)
- Dikokole Maqutu
- School of Statistics and Actuarial Science, University of KwaZulu-Natal, Private Bag X01, Scottsville 3209, South Africa
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Watt MH, Maman S, Golin CE, Earp JA, Eng E, Bangdiwala SI, Jacobson M. Factors associated with self-reported adherence to antiretroviral therapy in a Tanzanian setting. AIDS Care 2010; 22:381-9. [PMID: 20390519 DOI: 10.1080/09540120903193708] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to determine the level of antiretroviral adherence and factors associated with adherence among patients receiving free antiretroviral therapy (ART) at one clinic in Tanzania. Adult patients were recruited into the cross-sectional study and completed a survey that included self-reported adherence over four days and over one month. Less than 95% adherence on either measure was considered "poor." Factors associated with adherence in unadjusted analyses (alpha = 0.10) were included in a logistic regression model. A total of 340 patients participated in the study, and 5.9% (20/340) reported poor adherence. The final model found poor adherence associated with: being young (odds ratio (OR) = 4.03) or old (OR = 6.68); having lower perceived quality of patient-provider interaction (OR = 2.75); and ever missing a clinic appointment (OR = 3.13). Results highlight good adherence, but suggest the importance of addressing: (1) age-specific challenges of adherence through counseling and support; (2) client-focused care and quality of patient-provider interaction; and (3) clinic appointment reminder systems.
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Affiliation(s)
- Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA.
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31
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Sandelowski M, Voils CI, Chang Y, Lee EJ. A systematic review comparing antiretroviral adherence descriptive and intervention studies conducted in the USA. AIDS Care 2010; 21:953-66. [PMID: 20024751 DOI: 10.1080/09540120802626212] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We examined the extent to which studies aimed at testing interventions to improve antiretroviral adherence have targeted the facilitators of and barriers known to affect adherence. Of the 88 reports reviewed, 41 were reports of descriptive studies conducted with US HIV-positive women and 47 were reports of intervention studies conducted with US HIV-positive persons. We extracted from the descriptive studies all findings addressing any factor linked to antiretroviral adherence and from the intervention studies, information on the nature of the intervention, the adherence problem targeted, the persons targeted for the intervention, and the intervention outcomes desired. We discerned congruence between the prominence of substance abuse as a factor identified in the descriptive studies as a barrier to adherence and its prominence as the problem most addressed in those reports of intervention studies that specified the problems targeted for intervention. We also discerned congruence between the prominence of family and provider support as factors identified in the descriptive studies as facilitators of adherence and the presence of social support as an intervention component and outcome variable. Less discernible in the reports of intervention studies was specific attention to other factors prominent in the descriptive studies, which may be due to the complex nature of the problem, individualistic and rationalist slant of interventions, or simply the ways interventions were presented. Our review raises issues about niche standardization and intervention tailoring, targeting, and fidelity.
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Voils C, Hassselblad V, Crandell J, Chang Y, Lee E, Sandelowski M. A Bayesian method for the synthesis of evidence from qualitative and quantitative reports: the example of antiretroviral medication adherence. J Health Serv Res Policy 2009; 14:226-33. [PMID: 19770121 DOI: 10.1258/jhsrp.2009.008186] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Bayesian meta-analysis is a frequently cited but very little-used method for synthesizing qualitative and quantitative research findings. The only example published to date used qualitative data to generate an informative prior probability and quantitative data to generate the likelihood. We developed a method to incorporate both qualitative and quantitative evidence in the likelihood in a Bayesian synthesis of evidence about the relationship between regimen complexity and medication adherence. METHODS Data were from 11 qualitative and six quantitative studies. We updated two different non-informative prior distributions with qualitative and quantitative findings to find the posterior distribution for the probabilities that a more complex regimen was associated with lower adherence and that a less complex regimen was associated with greater adherence. RESULTS The posterior mode for the qualitative findings regarding more complex regimen and lesser adherence (using the uniform prior with Jeffreys' prior yielding highly similar estimates) was 0.588 (95% credible set limits 0.519, 0.663) and for the quantitative findings was 0.224 (0.203, 0.245); due to non-overlapping credible sets, we did not combine them. The posterior mode for the qualitative findings regarding less complex regimen and greater adherence was 0.288 (0.214, 0.441) and for the quantitative findings was 0.272 (0.118, 0.437); the combined estimate was 0.299 (0.267, 0.334). CONCLUSIONS The utility of Bayesian methods for synthesizing qualitative and quantitative research findings at the participant level may depend on the nature of the relationship being synthesized and on how well the findings are represented in the individual reports.
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Affiliation(s)
- Corrine Voils
- Health Services Research & Development Service, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA.
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33
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Telephone Nurse Counseling Improves HIV Medication Adherence: An Effectiveness Study. J Assoc Nurses AIDS Care 2009; 20:316-25. [DOI: 10.1016/j.jana.2009.02.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 02/20/2009] [Indexed: 11/15/2022]
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Chang Y, Voils CI, Sandelowski M, Hasselblad V, Crandell JL. Transforming verbal counts in reports of qualitative descriptive studies into numbers. West J Nurs Res 2009; 31:837-52. [PMID: 19448052 DOI: 10.1177/0193945909334434] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reports of qualitative studies typically do not offer much information on the numbers of respondents linked to any one finding. This information may be especially useful in reports of basic, or minimally interpretive, qualitative descriptive studies focused on surveying a range of experiences in a target domain, and its lack may limit the ability to synthesize the results of such studies with quantitative results in systematic reviews. Accordingly, the authors illustrate strategies for deriving plausible ranges of respondents expressing a finding in a set of reports of basic qualitative descriptive studies on antiretroviral adherence and suggest how the results might be used. These strategies have limitations and are never appropriate for use with findings from interpretive qualitative studies. Yet they offer a temporary workaround for preserving and maximizing the value of information from basic qualitative descriptive studies for systematic reviews. They show also why quantitizing is never simply quantitative.
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Affiliation(s)
- YunKyung Chang
- University of North Carolina at Chapel Hill School of Nursing, NC, USA.
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35
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Watt MH, Maman S, Earp JA, Eng E, Setel PW, Golin CE, Jacobson M. "It's all the time in my mind": facilitators of adherence to antiretroviral therapy in a Tanzanian setting. Soc Sci Med 2009; 68:1793-800. [PMID: 19328609 DOI: 10.1016/j.socscimed.2009.02.037] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Indexed: 11/15/2022]
Abstract
Although HIV positive patients' adherence to antiretroviral therapy (ART) is relatively high in African nations, as compared with industrialized nations, few studies have explored why. In the research presented here we aimed to understand the dynamics of good adherence to ART among patients receiving free ART and HIV-related services from a clinic in Arusha, Tanzania. We conducted individual semi-structured interviews with 6 health care providers and 36 patients at a health care center in Arusha in 2006. Interviews were conducted in Swahili using interview guides informed by social cognitive theory. All interviews were audio-recorded, transcribed in Kiswahili, translated into English and coded for themes and patterns with ATLAS.ti. Of the 36 patients interviewed (mean time on ART 9.8 months; range 1-23 months), 32 reported perfect adherence in the previous month. Self-reported adherence was high despite economic hardship, depression, low rates of HIV disclosure and high perceived HIV-associated stigma. Five factors emerged to explain excellent adherence in the face of such barriers. First, all respondents experienced substantial improvements in their health after starting ART; this supported their confidence in the medication and motivated them to adhere. Second, their perceived need to be able to meet their family responsibilities motivated respondents to stay healthy. Third, respondents developed specific strategies to remember to take pills, particularly routinizing pill-taking by linking it with daily activities or events. Fourth, material and emotional support received from others facilitated adherence. Finally, respondents trusted the advice and instructions of their health care providers, who regularly emphasized adherence. The facilitating factors identified were consistent with the constructs of social cognitive theory and highlighted the importance of interventions that address multiple levels of influence on adherence.
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Affiliation(s)
- Melissa H Watt
- Duke Global Health Institute, Duke University, 235 Trent Hall, Trent Drive, Box 90519, Durham, NC 27708, USA.
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36
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Carosi G, Nasta P, Fiore S, Matteelli A, Cauda R, Ferrazzi E, Tamburrini E, Savasi V, Bini T, Ravizza M, Bucceri A, Vichi F, Murri R, Mazzotta F, d'Arminio Monforte A. Women facing HIV. Key question on women with HIV infection: Italian consensus workshop. Infection 2009; 37:168-78. [PMID: 19308320 DOI: 10.1007/s15010-008-7361-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2007] [Accepted: 10/06/2008] [Indexed: 01/13/2023]
Abstract
A panel of leading Italian specialists in infectious diseases, obstetrics and gynaecology met in a national consensus workshop on women facing HIV to review critical aspects and discuss recommendations for selected key questions on four issues: (1) women and highly active antiretroviral therapy (HAART): access to care and adherence to therapy, side effects and drug-drug interaction; (2) HIV-infected pregnant women: prevention of mother to child transmission; (3) desire for children among women living with HIV: assisted reproduction; (4) sexually transmitted diseases and genital disturbances. The method of a nominal group meeting was used, and recommendations were graded for their strength and quality of evidence using a system based on the one adopted by the Infectious Diseases Society of America. Main conclusions are summarized and critically discussed, and some of the most recent data supporting recommendations are provided.
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Affiliation(s)
- G Carosi
- Institute of Infectious and Tropical Diseases, University of Brescia, Italy
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Willard S, Holzemer WL, Wantland DJ, Cuca YP, Kirksey KM, Portillo CJ, Corless IB, Rivero-Méndez M, Rosa ME, Nicholas PK, Hamilton MJ, Sefcik E, Kemppainen J, Canaval G, Robinson L, Moezzi S, Human S, Arudo J, Eller LS, Bunch E, Dole PJ, Coleman C, Nokes K, Reynolds NR, Tsai YF, Maryland M, Voss J, Lindgren T. Does "asymptomatic" mean without symptoms for those living with HIV infection? AIDS Care 2009; 21:322-8. [PMID: 19280409 PMCID: PMC3630501 DOI: 10.1080/09540120802183511] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Throughout the history of the HIV epidemic, HIV-positive patients with relatively high CD4 counts and no clinical features of opportunistic infections have been classified as "asymptomatic" by definition and treatment guidelines. This classification, however, does not take into consideration the array of symptoms that an HIV-positive person can experience long before progressing to AIDS. This short report describes two international multi-site studies conducted in 2003-2005 and 2005-2007. The results from the studies show that HIV-positive people may experience symptoms throughout the trajectory of their disease, regardless of CD4 count or classification. Providers should discuss symptoms and symptom management with their clients at all stages of the disease.
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Affiliation(s)
- Suzanne Willard
- Assistant Professor, Drexel University, College of Nursing and Health Professions, Elizabeth Glaser Pediatric AIDS Foundation, 1140 Connecticut Avenue, NW, Suite 200, Washington, DC 20036, T: 202 448-8491
| | - William L. Holzemer
- Professor and Associate Dean, UCSF School of Nursing, 2 Koret Way, Box 0608, San Francisco, CA 94143-0608, T: 415-476-2763, F: 415-476-6042
| | - Dean J. Wantland
- Assistant Adjunct Professor, UCSF School of Nursing, 2 Koret Way, Box 0608, San Francisco, CA 94143-0608, T: 415-613-4107, F: 415-476-6042
| | - Yvette P. Cuca
- Project Director, UCSF School of Nursing, 2 Koret Way, Box 0608, San Francisco, CA 94143-0608, T: 415-502-8081, F: 415-476-6042
| | - Kenn M. Kirksey
- Director of Nursing Research, SETON Family of Hospitals, 1601 Rio Grande, Suite 300, Austin, Texas 78701, T: 512-324-8988
| | - Carmen J. Portillo
- Professor, UCSF School of Nursing, 2 Koret Way, Box 0608, San Francisco, CA 94143-0608, T: 415-476-1630, F: 415-476-6042
| | - Inge B. Corless
- MGH Institute of Health Professions, CNY 36 1 Ave, Boston, MA 02129, T: 617-726-8018, F: 617-724-6321
| | - Marta Rivero-Méndez
- Professor, University of Puerto Rico, Medical Sciences Campus, School of Nursing, P.O. Box 365067, San Juan, Puerto Rico 00936-5067, T: 787-758-2525, x2114, F: 787-281-0721
| | - María E. Rosa
- Dean and Professor, Universidad del Turabo, School of Health Sciences, PO Box 3030, Gurabo, PR 00778, T: 787-743-7979 x 4017/4462, F: 787-704-2703
| | - Patrice K. Nicholas
- Director of Global Health and Academic Partnerships, Professor, MGH Institute of Health Professions, Brigham and Women’s Hospital, One Brigham Circle 4th Floor, Boston, MA 02115, T: 617-525-7790
| | - Mary Jane Hamilton
- Dean & Professor, Texas A&M University - Corpus Christi, College of Nursing & Health Science, 6300 Ocean Drive, Corpus Christi, TX 78412, T: 361-825-2649, F: 361-825-2484
| | - Elizabeth Sefcik
- Professor, Texas A&M University - Corpus Christi, 6300 Ocean Drive, Corpus Christi, TX 78412, T: 361-825-5857
| | - Jeanne Kemppainen
- Associate Professor, School of Nursing, The University of North Carolina at Wilmington, 1080 St. Joseph St., 3B, Carolina Beach, NC 28428, T: 910-962-3202, H: 910-458-3788
| | - Gladys Canaval
- Universidad del Valle, A.A. 25360 Cali, Valle, Colombia, T: 57-2-3391437 ext 110, F: 57-2-5581938
| | - Linda Robinson
- Associate Professor, University of San Diego, Hahn School of Nursing, 5998 Alcala Park, San Diego, CA, T: 619-260-4571, F: 619-260-6814
| | - Shahnaz Moezzi
- Assistant Professor, University of Utah, College of Nursing, 1340 Michigan Ave., Salt Lake City, UT 84105, T: 801-587-9128, F: 801-581-4642
| | - Sarie Human
- University of South Africa, Department of Health Studies, PO Box 392, Unisarand, UNISA, Pretoria, 0003, South Africa, T: 27-12-429-6290, F: 27-12-429-6688
| | - John Arudo
- Regional Research Co-ordinator, Aga Khan University Advanced Nursing Programme, PO Box 39340-00623, Nairobi, Kenya, T: 254-20-374-74-83, F: 254-20-374-7004
| | - Lucille Sanzero Eller
- Associate Professor, Rutgers, the State University of New Jersey, 180 University Ave., Suite 102, Newark, NJ 07102, T: 973-353-5326 x503, F: 973-353-1277
| | - Eli Bunch
- Professor, University of Oslo, Institute of Nursing Science, POB 1153, Blindern, 0318, Oslo Norway, T: 47-22-85-05-60, F: 47-22-85-05-70
| | - Pamela J. Dole
- Village Diagnostic and Treatment Center, 121A W 20 Street, New York, NY 10011, T: 212-337-9290, F: 212-337-9254
| | - Christopher Coleman
- University of Pennsylvania, School of Nursing, Philadelphia, PA 19104-6096, T: 215-898-0760, F: 215-573-7496
| | - Kathleen Nokes
- Professor, Hunter College, CUNY, Hunter-Bellevue School of Nursing, 425 East 25 St., Box 874, New York, NY 10010, T: 212-481-7594, F: 212-481-4427
| | - Nancy R. Reynolds
- Yale University, School of Nursing, P.O. Box 9740, 100 Church Street South, Suite 200, New Haven, CT 06536-0740, T: 203-737-2313, F: 203-785-6455
| | - Yun-Fang Tsai
- Professor, School of Nursing, Chang Gung University, 259 Wen Hua 1 Road, Kwei-Shan, Tao-Yuan 333, Taiwan, ROC, T: 011-886-3-3283016 ext 5958, F: 011-886-3-211868
| | - Mary Maryland
- University of Illinois at Chicago, College of Medicine, Hematology Oncology, 820 S. Wood St., Suite 172 (M/C 712), Chicago, Illinois 60612, T: 312-413-2042, F: 312-996-5984
| | - Joachim Voss
- Assistant Professor, University of Washington, School of Nursing, Dept. of Biobehavioral Nursing and Health Systems, UW Box 357266, Room T 624B, Seattle, WA 98195, T: 206-616-7819, F: 206-543-4771
| | - Teri Lindgren
- Project Director, UCSF School of Nursing, 2 Koret Way, Box 0606, San Francisco, CA 94143-0606, T: 415-504-7892
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Royer HR, Zahner SJ. Providers' Experiences with Young People's Cognitive Representations and Emotions Related to the Prevention and Treatment of Sexually Transmitted Infections. Public Health Nurs 2009; 26:161-72. [DOI: 10.1111/j.1525-1446.2009.00767.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sabin LL, Desilva MB, Hamer DH, Keyi X, Yue Y, Wen F, Tao L, Heggenhougen HK, Seton L, Wilson IB, Gill CJ. Barriers to adherence to antiretroviral medications among patients living with HIV in southern China: a qualitative study. AIDS Care 2009; 20:1242-50. [PMID: 19012083 DOI: 10.1080/09540120801918651] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Although China's government is rapidly expanding access to antiretroviral therapy, little is known about barriers to adherence among Chinese HIV-infected patients, particularly among injection drug users. To better understand barriers to antiretroviral treatment adherence, we conducted a qualitative research study, using both focus group and key informant methods, among 36 HIV-positive men and women in Dali, in southwestern China. All interviews utilized semi-structured question guides and were conducted in Mandarin, audio-recorded and translated into English for analysis. The most commonly cited adherence challenges were stigma, including secondary stigma experienced by family members; mental health issues; and economic concerns, particularly related to finding and maintaining employment. Distinctive gender differences emerged, partly due to previous heroin use among male respondents. Optimizing adherence may require that antiretroviral therapy programs be linked to other services, including drug addiction treatment, mental health services and vocational treatment and support. HIV care and service providers and policy makers in China responsible for HIV treatment should be aware of these important barriers to adherence.
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Affiliation(s)
- Lora L Sabin
- Center for International Health and Development, Boston University, Boston, MA, USA.
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40
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Guimarães MDC, Rocha GM, Campos LN, de Freitas FMT, Gualberto FAS, Teixeira RDAR, de Castilho FM. Difficulties reported by HIV-infected patients using antiretroviral therapy in Brazil. Clinics (Sao Paulo) 2008; 63:165-72. [PMID: 18438569 PMCID: PMC2664217 DOI: 10.1590/s1807-59322008000200003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Accepted: 11/09/2007] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To describe the degree of difficulty that HIV-infected patients have with therapy treatment. INTRODUCTION Patients perceptions about their treatment are a determinant factor for improved adherence and a better quality of life. METHODS Two cross-sectional analyses were conducted in public AIDS referral centers in Brazil among patients initiating treatment. Patients interviewed at baseline, after one month, and after seven months following the beginning of treatment were asked to classify and justify the degree of difficulty with treatment. Logistic regression was used for analysis. RESULTS Among 406 patients initiating treatment, 350 (86.2%) and 209 (51.5%) returned for their first and third visits, respectively. Treatment perceptions ranged from medium to very difficult for 51.4% and 37.3% on the first and third visits, respectively. The main difficulties reported were adverse reactions to the medication and scheduling. A separate logistic regression indicated that the HIV-seropositive status disclosure, symptoms of anxiety, absence of psychotherapy, higher CD4+ cell count (> 200/mm3) and high (> 4) adverse reaction count reported were independently associated with the degree of difficulty in the first visit, while CDC clinical category A, pill burden (> 7 pills), use of other medications, high (> 4) adverse reaction count reported and low understanding of medical orientation showed independent association for the third visit. CONCLUSIONS A significant level of difficulty was observed with treatment. Our analyses suggest the need for early assessment of difficulties with treatment, highlighting the importance of modifiable factors that may contribute to better adherence to the treatment protocol.
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Affiliation(s)
- Mark Drew Crosland Guimarães
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
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41
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Wayson Locher A, Pargament K, Duggan J. Antiretroviral therapy in the lives of women of colour with HIV. AIDS Care 2008; 19:1048-51. [PMID: 17852003 DOI: 10.1080/09540120701335253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Non-adherence to antiretroviral medication is associated with adverse patient outcomes. Considerable research and clinical work has focused on issues surrounding patient compliance to prescribed regimens. Few studies have explored the essence of antiretroviral medications in the lives of women of colour with HIV. A qualitative study of HIV-infected women of colour was undertaken in response to the question: What is the role of antiretroviral medication in your life? Taped interviews were conducted with graduate psychology students and commercially transcribed. Transcriptions were analyzed by Spiegelberg's category-cluster-theme process by four different reviewers. Three themes were distilled: trust/mistrust, approach/avoidance motivation and 'constantly tethered'. Strategies designed to increase medication adherence may need to consider these basic themes in order to be successful.
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Affiliation(s)
- A Wayson Locher
- Ryan White Title IV Family Centered HIV Clinic, Medical University of Ohio, Toledo, OH 43614, USA.
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42
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Sandelowski M, Barroso J, Voils CI. Using qualitative metasummary to synthesize qualitative and quantitative descriptive findings. Res Nurs Health 2007; 30:99-111. [PMID: 17243111 PMCID: PMC2329806 DOI: 10.1002/nur.20176] [Citation(s) in RCA: 226] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The new imperative in the health disciplines to be more methodologically inclusive has generated a growing interest in mixed research synthesis, or the integration of qualitative and quantitative research findings. Qualitative metasummary is a quantitatively oriented aggregation of qualitative findings originally developed to accommodate the distinctive features of qualitative surveys. Yet these findings are similar in form and mode of production to the descriptive findings researchers often present in addition to the results of bivariate and multivariable analyses. Qualitative metasummary, which includes the extraction, grouping, and formatting of findings, and the calculation of frequency and intensity effect sizes, can be used to produce mixed research syntheses and to conduct a posteriori analyses of the relationship between reports and findings.
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43
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Mendias EP, Paar DP. Perceptions of health and self-care learning needs of outpatients with HIV/AIDS. J Community Health Nurs 2007; 24:49-64. [PMID: 17266405 DOI: 10.1080/07370010709336585] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Health promotion increases healthy behaviors, enhances health status, and decreases health care costs of chronically ill persons. As HIV has become a chronic illness, many HIV-positive persons may have health learning needs that affect their behaviors, health status, and health care costs. Health learning needs may be general or HIV specific. Social stigma may affect learning resource usage. We used Pender's Health Promotion Model and community-based health promotion principles as theoretical underpinnings for an exploratory study of perceived health and self-care learning needs, barriers, and preferred learning modalities of outpatients with HIV/AIDS. A nonrandom sample of 151 adults completed a researcher-designed self-report survey. Most (97%) expressed interest in health and self-care. Many identified multiple topics, learning barriers, and preferred learning modalities. A statistically significant difference (p=.027) was noted in communication needs of participants diagnosed with HIV versus AIDS. Findings have led to practice changes, health promotion activities, and further research.
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Affiliation(s)
- Elnora P Mendias
- The University of Texas Medical Branch School of Nursing, Galveston, TX 77555-1029, USA.
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44
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Vervoort SCJM, Borleffs JCC, Hoepelman AIM, Grypdonck MHF. Adherence in antiretroviral therapy: a review of qualitative studies. AIDS 2007; 21:271-81. [PMID: 17255734 DOI: 10.1097/qad.0b013e328011cb20] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sigrid C J M Vervoort
- Department of Acute Medicine and Infectious Diseases, University Medical Centre, 3508 GA Utrecht, the Netherlands.
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45
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Sankar A, Golin C, Simoni JM, Luborsky M, Pearson C. How qualitative methods contribute to understanding combination antiretroviral therapy adherence. J Acquir Immune Defic Syndr 2006; 43 Suppl 1:S54-68. [PMID: 17133205 PMCID: PMC4216722 DOI: 10.1097/01.qai.0000248341.28309.79] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Strict adherence to medication regimens is generally required to obtain optimal response to combination antiretroviral therapy (ART). Yet, we have made limited progress in developing strategies to decrease the prevalence of nonadherence. As we work to understand adherence in developed countries, the introduction of ART in resource-poor settings raises novel challenges. Qualitative research is a scientific approach that uses methods such as observation, interviews, and verbal interactions to gather rich in-depth information about how something is experienced. It seeks to understand the beliefs, values, and processes underlying behavioral patterns. Qualitative methods provide powerful tools for understanding adherence. Culture-specific influences, medication beliefs, access, stigma, reasons for nonadherence, patterns of medication taking, and intervention fidelity and measurement development are areas ripe for qualitative inquiry. A disregard for the social and cultural context of adherence or the imposition of adherence models inconsistent with local values and practices is likely to produce irrelevant or ineffective interventions. Qualitative methods remain underused in adherence research. We review appropriate qualitative methods for and provide an overview of the qualitative research on ART nonadherence. We discuss the rationales for using qualitative methods, present 2 case examples illustrating their use, and discuss possible institutional barriers to their acceptance.
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Affiliation(s)
- Andrea Sankar
- Department of Anthropology, Wayne State University, Detroit, Michigan 48202, USA.
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Mills EJ, Nachega JB, Bangsberg DR, Singh S, Rachlis B, Wu P, Wilson K, Buchan I, Gill CJ, Cooper C. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med 2006; 3:e438. [PMID: 17121449 PMCID: PMC1637123 DOI: 10.1371/journal.pmed.0030438] [Citation(s) in RCA: 556] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Accepted: 09/04/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adherence to highly active antiretroviral therapy (HAART) medication is the greatest patient-enabled predictor of treatment success and mortality for those who have access to drugs. We systematically reviewed the literature to determine patient-reported barriers and facilitators to adhering to antiretroviral therapy. METHODS AND FINDINGS We examined both developed and developing nations. We searched the following databases: AMED (inception to June 2005), Campbell Collaboration (inception to June 2005), CinAhl (inception to June 2005), Cochrane Library (inception to June 2005), Embase (inception to June 2005), ERIC (inception to June 2005), MedLine (inception to June 2005), and NHS EED (inception to June 2005). We retrieved studies conducted in both developed and developing nation settings that examined barriers and facilitators addressing adherence. Both qualitative and quantitative studies were included. We independently, in duplicate, extracted data reported in qualitative studies addressing adherence. We then examined all quantitative studies addressing barriers and facilitators noted from the qualitative studies. In order to place the findings of the qualitative studies in a generalizable context, we meta-analyzed the surveys to determine a best estimate of the overall prevalence of issues. We included 37 qualitative studies and 47 studies using a quantitative methodology (surveys). Seventy-two studies (35 qualitative) were conducted in developed nations, while the remaining 12 (two qualitative) were conducted in developing nations. Important barriers reported in both economic settings included fear of disclosure, concomitant substance abuse, forgetfulness, suspicions of treatment, regimens that are too complicated, number of pills required, decreased quality of life, work and family responsibilities, falling asleep, and access to medication. Important facilitators reported by patients in developed nation settings included having a sense of self-worth, seeing positive effects of antiretrovirals, accepting their seropositivity, understanding the need for strict adherence, making use of reminder tools, and having a simple regimen. Among 37 separate meta-analyses examining the generalizability of these findings, we found large heterogeneity. CONCLUSIONS We found that important barriers to adherence are consistent across multiple settings and countries. Research is urgently needed to determine patient-important factors for adherence in developing world settings. Clinicians should use this information to engage in open discussion with patients to promote adherence and identify barriers and facilitators within their own populations.
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Affiliation(s)
- Edward J Mills
- Centre for International Health and Human Rights Studies, Toronto, Ontario, Canada.
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47
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Abel E, Hopson L, Delville C. Health promotion for women with human immunodeficiency virus or acquired immunodeficiency syndrome. ACTA ACUST UNITED AC 2006; 18:534-43. [PMID: 17064331 DOI: 10.1111/j.1745-7599.2006.00169.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this pilot study was twofold: first, to modify Stuifbergen's health promotion intervention initially developed for women with multiple sclerosis for use among women with human immunodeficiency virus or acquired immunodeficiency syndrome (HIV/AIDS) and to evaluate the feasibility of the newly modified health promotion intervention named "Put Health Into Living" (PHIL). The pilot study was completed in two phases. DATA SOURCES In phase I, data were derived from a literature review, a focus group of women with HIV/AIDS (n= 7), a panel of experts who reviewed the intervention for content, and three female community workers who evaluated the intervention for the context of living with HIV/AIDS, cultural relevancy, and literacy. During phase II, a pretest/posttest one-group design was used to determine the feasibility of the study methods, content, and format of the health promotion intervention among 10 women with HIV/AIDS. CONCLUSIONS The pilot study demonstrated the importance of a health promotion intervention for a vulnerable population. Participants verbalized the benefits of attending a health promotion program to gain knowledge and skills to promote their health. One woman said, "I have been positive for 20 years now and no one has talked to me just about my overall health." Participants indicated the PHIL intervention offered a supportive group environment, an overall health focus, and an acceptable format. IMPLICATIONS FOR PRACTICE Health promotion is a desirable goal for persons living with a chronic disease, and the PHIL intervention has the potential to benefit persons living with HIV/AIDS if subsequent evidence is found in further testing of the intervention.
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Affiliation(s)
- Elizabeth Abel
- School of Nursing, The University of Texas at Austin, Austin, Texas, USA.
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Abstract
As the number of women living with HIV and AIDS increases, so does survival time for individuals living with this chronic condition. Symptom existence, intensity, and bothersomeness greatly affect quality of life in women living with HIV and AIDS. Symptoms experienced by women living with HIV include symptoms related to HIV infection itself, those related to opportunistic infections, and those related to medications and treatments. Symptoms experienced by women include those common to both genders and those specific to females. The presence and intensity of symptoms varies with progression of the disease and with deteriorating status of HIV disease indicators. While research is limited on this topic, some research on the general symptom experience of women and on symptoms specific to or common among women has been done. Extended life expectancy among women with HIV increases the importance of nursing care focused on symptom assessment and symptom management. This article reviews research on symptoms commonly experienced by women living with HIV and presents implications for the care of women experiencing distressing symptoms.
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Affiliation(s)
- Claire E Lindberg
- The College of New Jersey, School of Nursing, PO Box 7718, Ewing, NJ 08628, USA.
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49
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Fehringer J, Bastos FI, Massard E, Maia L, Pilotto JH, Kerrigan D. Supporting adherence to highly active antiretroviral therapy and protected sex among people living with HIV/AIDS: the role of patient-provider communication in Rio de Janeiro, Brazil. AIDS Patient Care STDS 2006; 20:637-48. [PMID: 16987050 DOI: 10.1089/apc.2006.20.637] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This exploratory study examined patient-provider communication dynamics regarding adherence to highly active antiretroviral therapy (HAART) and protective sexual behavior among people living with HIV/AIDS (PLWHA). We conducted 20 direct observations of routine consultations between PLWHA and care providers in two large public health clinics providing free HIV medications and clinical care to PLWHA in the greater Rio de Janeiro area of Brazil. Immediately after these observations, 20 semistructured in-depth interviews were conducted with observation participants regarding their communication with providers, overall clinic experience, and questions and concerns about adherence to HAART and safe sex. Findings from observations showed that patient-provider communication focused almost exclusively on biomedical aspects of HIV-related treatment such as symptom management. In most observations, adherence to HAART was addressed. However, questions posed by providers regarding adherence were generally close-ended and leading, discouraging an open exchange regarding potential difficulties related to adherence. HIV/sexually transmitted infection (STI)- related protective behaviors were seldom addressed except when the patient displayed STI symptoms or was thought to be pregnant. In qualitative interviews, patients generally reported satisfaction with their providers, but also reported a variety of concerns and challenges related to adherence to HAART and protective sexual behavior that were not expressed in patient-provider interactions. We conclude that one way in which adherence to HAART and protective sexual behavior among PLWHA could be facilitated is by improving patient- provider communication on these topics, including increasing the frequency of openended, nonjudgmental dialogue initiated by care providers.
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Affiliation(s)
- Jessica Fehringer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
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Abstract
Time and timeliness are key issues in appraising and ensuring the clinical relevance of systematic reviews. Time considerations entering the systematic review process include the history of the clinical problem, disease, or treatment that is the target of the review, and the history of the research conducted to address it. These considerations guide: (i) formulation of the research problems and questions; (ii) setting of parameters for the search and retrieval of studies; (iii) determination of inclusion and exclusion criteria; (iv) appraisal of the clinical relevance of findings; (v) selection of the findings that will be synthesized; and (vi) interpretation of the results of that synthesis.
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Affiliation(s)
- Julie Barroso
- Duke University School of Nursing, Durham, NC 27710, USA.
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