PDF(Pubmed)
Abstract：
There is limited study of persons deemed \"harder to reach\" by HIV treatment services, including those discontinuing or never initiating antiretroviral therapy (ART). We conducted narrative research in southern Uganda with virologically unsuppressed persons identified through population-based sampling to discern longitudinal patterns in HIV service engagement and identify factors shaping treatment persistence.
In mid-2022, we sampled adult participants with high-level HIV viremia (≥1000 RNA copies/mL) from the prospective, population-based Rakai Community Cohort Study. Using life history calendars, we conducted initial and follow-up in-depth interviews to elicit oral histories of participants\' journeys in HIV care, from diagnosis to the present. We then used thematic trajectory analysis to identify discrete archetypes of HIV treatment engagement by \"re-storying\" participant narratives and visualizing HIV treatment timelines derived from interviews and abstracted clinical data.
Thirty-eight participants (median age: 34 years, 68% men) completed 75 interviews. We identified six HIV care engagement archetypes from narrative timelines: (1) delayed ART initiation, (2) early treatment discontinuation, (3) treatment cycling, (4) prolonged treatment interruption, (5) transfer-related care disruption, and (6) episodic viremia. Patterns of service (dis)engagement were highly gendered, occurred in the presence and absence of optimal ART adherence, and were shaped by various factors emerging at different time points, including: denial of HIV serostatus and disclosure concerns; worsening HIV-related symptoms; psychological distress and depression; social support; intimate partner violence; ART side effects; accessibility constraints during periods of mobility; incarceration; and inflexible ART dispensing regulations.
Identified trajectories uncovered heterogeneities in both the timing and drivers of ART (re-)initiation and (dis)continuity, demonstrating the distinct characteristics and needs of people with different patterns of HIV treatment engagement throughout the life course. Enhanced mental health service provision, expanded eligibility for differentiated service delivery models, and streamlined facility switching processes may facilitate timely (re-)engagement in HIV services.
In mid-2022, we sampled adult participants with high-level HIV viremia (≥1000 RNA copies/mL) from the prospective, population-based Rakai Community Cohort Study. Using life history calendars, we conducted initial and follow-up in-depth interviews to elicit oral histories of participants\' journeys in HIV care, from diagnosis to the present. We then used thematic trajectory analysis to identify discrete archetypes of HIV treatment engagement by \"re-storying\" participant narratives and visualizing HIV treatment timelines derived from interviews and abstracted clinical data.
Thirty-eight participants (median age: 34 years, 68% men) completed 75 interviews. We identified six HIV care engagement archetypes from narrative timelines: (1) delayed ART initiation, (2) early treatment discontinuation, (3) treatment cycling, (4) prolonged treatment interruption, (5) transfer-related care disruption, and (6) episodic viremia. Patterns of service (dis)engagement were highly gendered, occurred in the presence and absence of optimal ART adherence, and were shaped by various factors emerging at different time points, including: denial of HIV serostatus and disclosure concerns; worsening HIV-related symptoms; psychological distress and depression; social support; intimate partner violence; ART side effects; accessibility constraints during periods of mobility; incarceration; and inflexible ART dispensing regulations.
Identified trajectories uncovered heterogeneities in both the timing and drivers of ART (re-)initiation and (dis)continuity, demonstrating the distinct characteristics and needs of people with different patterns of HIV treatment engagement throughout the life course. Enhanced mental health service provision, expanded eligibility for differentiated service delivery models, and streamlined facility switching processes may facilitate timely (re-)engagement in HIV services.
摘要：
背景：对艾滋病毒治疗服务认为“难以接触”的人进行的研究有限，包括那些停止或从未开始抗逆转录病毒治疗（ART）。我们在乌干达南部进行了叙述性研究，通过基于人群的抽样确定了病毒学上未受抑制的人，以辨别HIV服务参与的纵向模式，并确定影响治疗持久性的因素。
方法：在2022年中期，我们从前瞻性，基于人群的Rakai社区队列研究。使用生活史日历，我们进行了初步和后续的深入访谈，以引出参与者的口述历史\在艾滋病毒护理的旅程，从诊断到现在然后，我们使用主题轨迹分析通过“重新报道”参与者的叙述并可视化从访谈和抽象的临床数据中得出的HIV治疗时间表来识别HIV治疗参与的离散原型。
结果：38名参与者（平均年龄：34岁，68%的男性)完成了75次访谈。我们从叙述时间表中确定了六种HIV护理参与原型：（1）延迟ART启动，（2）早期停药，（3）治疗循环，（4）长时间中断治疗，（5）与转移相关的护理中断，和（6）发作性病毒血症。服务(DIS)参与的模式是高度性别化的，在存在和不存在最佳ART依从性的情况下发生，并受到不同时间点出现的各种因素的影响，包括：否认艾滋病毒血清状态和披露问题；艾滋病毒相关症状恶化；心理困扰和抑郁；社会支持；亲密伴侣暴力；ART副作用；行动期间的可及性限制；监禁；和不灵活的ART分配规定。
结论：确定的轨迹揭示了ART（重新）启动和（非）连续性的时机和驱动因素的异质性，展示了在整个生命过程中参与艾滋病毒治疗的不同模式的人的独特特征和需求。加强精神卫生服务的提供，扩大差异化服务交付模式的资格，简化的设施转换流程可能有助于及时(重新)参与艾滋病毒服务。
方法：在2022年中期，我们从前瞻性，基于人群的Rakai社区队列研究。使用生活史日历，我们进行了初步和后续的深入访谈，以引出参与者的口述历史\在艾滋病毒护理的旅程，从诊断到现在然后，我们使用主题轨迹分析通过“重新报道”参与者的叙述并可视化从访谈和抽象的临床数据中得出的HIV治疗时间表来识别HIV治疗参与的离散原型。
结果：38名参与者（平均年龄：34岁，68%的男性)完成了75次访谈。我们从叙述时间表中确定了六种HIV护理参与原型：（1）延迟ART启动，（2）早期停药，（3）治疗循环，（4）长时间中断治疗，（5）与转移相关的护理中断，和（6）发作性病毒血症。服务(DIS)参与的模式是高度性别化的，在存在和不存在最佳ART依从性的情况下发生，并受到不同时间点出现的各种因素的影响，包括：否认艾滋病毒血清状态和披露问题；艾滋病毒相关症状恶化；心理困扰和抑郁；社会支持；亲密伴侣暴力；ART副作用；行动期间的可及性限制；监禁；和不灵活的ART分配规定。
结论：确定的轨迹揭示了ART（重新）启动和（非）连续性的时机和驱动因素的异质性，展示了在整个生命过程中参与艾滋病毒治疗的不同模式的人的独特特征和需求。加强精神卫生服务的提供，扩大差异化服务交付模式的资格，简化的设施转换流程可能有助于及时(重新)参与艾滋病毒服务。
