PDF(Pubmed)
Abstract：
After more than two decades of the expansion of antiretroviral treatment (ART) in adolescents living with perinatal HIV (APHIV) in sub-Saharan Africa, there is still poorly sustained long-term adherence to ART due to multifactorial factors with the consequence of increased mortality and morbidity. There are little data available on the familial and structural factors which affect sustenance to long-term adherence to ART. A qualitative exploratory design was used to conduct in-depth interviews with 21 APHIV attending HIV care and management in the rural health facilities of Vhembe district in Limpopo Province, South Africa. Transcripts were translated verbatim into English, and data were analyzed using Tesch\'s eight steps of qualitative data analysis. The sample consisted of APHIV 10-19 years old who were aware of their HIV status, and all had received ART for more than 5 years. They lived in extended, disrupted, grandparent- and child-headed households. They experienced food insecurities due to poverty or orphanhood, as well as living in disrupted households, which deterred them from long-term adherence. In addition, dependency on social support grants to sustain their livelihoods affected long-term adherence. APHIV had challenges with structural factors such as inconsistent clinic attendance, clashes between school activities and clinic appointments, and the lack of transport fare to the clinic, which affected adherence. Although APHIV were on one-pill fixed-dose ART, they were not able to sustain long-term adherence due to various familial, structural, and psychosocial challenges. In addition to institution-based interventions, there is a need for family, community-based, and multi-sectorial interventions to support long-term ART adherence among APHIV.
摘要：
在撒哈拉以南非洲，在围产期感染艾滋病毒（APHIV）的青少年中扩大抗逆转录病毒治疗（ART）二十多年后，由于多因素导致死亡率和发病率增加,ART的长期依从性仍然较差.关于影响长期坚持ART的家庭和结构因素的数据很少。采用定性探索性设计，对在林波波省Vhembe区农村医疗机构接受艾滋病毒护理和管理的21名APHIV患者进行了深入访谈，南非。成绩单被逐字翻译成英文，并使用Tesch的8个定性数据分析步骤对数据进行分析。样本包括10-19岁的APHIV，他们知道自己的HIV状况，他们都接受了超过5年的ART治疗。他们住在延长，中断,祖父母和儿童为户主的家庭。他们经历了由于贫困或孤儿而导致的食物不安全感，以及生活在混乱的家庭中，这阻止了他们长期坚持。此外,依赖社会支持赠款来维持他们的生计影响了长期坚持。APHIV面临着结构性因素的挑战，例如不一致的诊所出勤率，学校活动和诊所预约之间的冲突，缺乏去诊所的交通费，这影响了坚持。尽管APHIV服用了一粒固定剂量的ART，由于各种家庭原因，他们无法长期坚持，结构,和心理社会挑战。除了基于机构的干预之外，有家庭的需要，以社区为基础,和多部门干预措施，以支持APHIV的长期ART依从性。
