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Abstract：
BACKGROUND: Even though quantitative studies have described barriers to anti-retroviral therapy (ART), a more exploratory approach will provide in-depth information on these issues, and potential suggestions to address these issues at individual as well as structural level. We designed this qualitative study to examine the barriers and facilitators for antiretroviral therapy adherence in key population (KP) in Mumbai, India. We also wanted to understand the strategies adopted by these groups and get suggestions to improve adherence to ART.
METHODS: This is a qualitative analysis of seven focus group discussions (FGDs) conducted with four KP subgroups in Mumbai. We conducted two FGDs each with female sex workers (FSW), men who have sex with men (MSM), male-to-female transgendered people/Hijras (TGH) each, and one FGD with people who inject drugs (IDU). We transcribed the audio-recorded electronic records of these FGDs. We also added the notes of the observers on the group dynamics to the transcribed data. We used the Framework Approach to analyse these data.
RESULTS: Some experiences-such as side effects to ART medicines-were common across groups. However, incarceration as a reason for stopping ART was reported by FSWs but not by other KPs. Friends and family (including Guru) are important support systems for HIV infected individuals and adherence to ART. Stigma and discrimination by community members and general community prevent regular access of ART centres and other health care facilities. Additional factors which led to missed doses were mental health issues, alcohol use, and misplacing the ART tablets during police raids or during robbery attempts at the cruising sites. Since a common source of discrimination among peers and the community was the presence of \'Green book\' (or their treatment book); the key population wanted the AIDS program to change it to digital cards so that labelling one as \'HIV positive\' for being seen with the book can be avoided.
CONCLUSIONS: The qualitative study helped us explore the barriers to ART among key population and the community provided specific suggestions to address them. In addition to Key Population centric enhanced adherence counselling, some administrative guidelines and procedures may need to be altered to improve adherence to ART in these populations.
METHODS: This is a qualitative analysis of seven focus group discussions (FGDs) conducted with four KP subgroups in Mumbai. We conducted two FGDs each with female sex workers (FSW), men who have sex with men (MSM), male-to-female transgendered people/Hijras (TGH) each, and one FGD with people who inject drugs (IDU). We transcribed the audio-recorded electronic records of these FGDs. We also added the notes of the observers on the group dynamics to the transcribed data. We used the Framework Approach to analyse these data.
RESULTS: Some experiences-such as side effects to ART medicines-were common across groups. However, incarceration as a reason for stopping ART was reported by FSWs but not by other KPs. Friends and family (including Guru) are important support systems for HIV infected individuals and adherence to ART. Stigma and discrimination by community members and general community prevent regular access of ART centres and other health care facilities. Additional factors which led to missed doses were mental health issues, alcohol use, and misplacing the ART tablets during police raids or during robbery attempts at the cruising sites. Since a common source of discrimination among peers and the community was the presence of \'Green book\' (or their treatment book); the key population wanted the AIDS program to change it to digital cards so that labelling one as \'HIV positive\' for being seen with the book can be avoided.
CONCLUSIONS: The qualitative study helped us explore the barriers to ART among key population and the community provided specific suggestions to address them. In addition to Key Population centric enhanced adherence counselling, some administrative guidelines and procedures may need to be altered to improve adherence to ART in these populations.
摘要：
背景：尽管定量研究已经描述了抗逆转录病毒治疗（ART）的障碍，更具探索性的方法将提供有关这些问题的深入信息，以及在个人和结构层面解决这些问题的潜在建议。我们设计了这项定性研究，以检查孟买关键人群（KP）抗逆转录病毒治疗依从性的障碍和促进因素，印度。我们还想了解这些小组采用的策略，并获得改善对ART的依从性的建议。
方法：这是对孟买四个KP亚组进行的七个焦点小组讨论（FGD）的定性分析。我们对女性性工作者（FSW）进行了两次FGD，男男性行为者(MSM),男女变性人/Hijras（TGH），和一个FGD与注射毒品的人（IDU）。我们转录了这些FGD的录音电子记录。我们还在转录的数据中添加了观察者关于群体动态的注释。我们使用框架方法来分析这些数据。
结果：一些经验——比如ART药物的副作用——在不同的群体中很常见。然而,FSW报告了将监禁作为停止ART的原因，但其他KP没有报告。朋友和家人（包括Guru）是HIV感染者和坚持ART的重要支持系统。社区成员和普通社区的污名和歧视阻碍了ART中心和其他医疗保健设施的定期访问。导致错过剂量的其他因素是心理健康问题，酒精使用,并在警察突袭或在巡航地点抢劫期间放错了ART平板电脑。由于同龄人和社区之间常见的歧视根源是“绿皮书”（或他们的治疗书）的存在；关键人群希望艾滋病计划将其更改为数字卡，以便可以避免将其标记为“艾滋病毒阳性”，以避免被这本书看到。
结论：定性研究帮助我们探索了主要人群中ART的障碍，社区为解决这些障碍提供了具体建议。除了以关键人群为中心的强化依从性咨询，可能需要改变一些行政指南和程序,以提高这些人群对ART的依从性.
方法：这是对孟买四个KP亚组进行的七个焦点小组讨论（FGD）的定性分析。我们对女性性工作者（FSW）进行了两次FGD，男男性行为者(MSM),男女变性人/Hijras（TGH），和一个FGD与注射毒品的人（IDU）。我们转录了这些FGD的录音电子记录。我们还在转录的数据中添加了观察者关于群体动态的注释。我们使用框架方法来分析这些数据。
结果：一些经验——比如ART药物的副作用——在不同的群体中很常见。然而,FSW报告了将监禁作为停止ART的原因，但其他KP没有报告。朋友和家人（包括Guru）是HIV感染者和坚持ART的重要支持系统。社区成员和普通社区的污名和歧视阻碍了ART中心和其他医疗保健设施的定期访问。导致错过剂量的其他因素是心理健康问题，酒精使用,并在警察突袭或在巡航地点抢劫期间放错了ART平板电脑。由于同龄人和社区之间常见的歧视根源是“绿皮书”（或他们的治疗书）的存在；关键人群希望艾滋病计划将其更改为数字卡，以便可以避免将其标记为“艾滋病毒阳性”，以避免被这本书看到。
结论：定性研究帮助我们探索了主要人群中ART的障碍，社区为解决这些障碍提供了具体建议。除了以关键人群为中心的强化依从性咨询，可能需要改变一些行政指南和程序,以提高这些人群对ART的依从性.
