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首页> 外文期刊>Frontiers in Public Health >Exploring How Substance Use Impedes Engagement along the HIV Care Continuum: A Qualitative Study
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Exploring How Substance Use Impedes Engagement along the HIV Care Continuum: A Qualitative Study

机译：定性研究探索物质使用如何阻碍HIV护理过程中的参与度

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Drug use is associated with low uptake of HIV antiretroviral therapy (ART), an under-studied step in the HIV care continuum, and insufficient engagement in HIV primary care. However, the specific underlying mechanisms by which drug use impedes these HIV health outcomes are poorly understood. The present qualitative study addresses this gap in the literature, focusing on African-American/Black and Hispanic persons living with HIV (PLWH) who had delayed, declined, or discontinued ART and who also were generally poorly engaged in health care. Participants (N = 37) were purposively sampled from a larger study for maximum variation on HIV indices. They engaged in 1–2 h audio-recorded in-depth semi-structured interviews on HIV histories guided by a multilevel social-cognitive theory. Transcripts were analyzed using a systematic content analysis approach. Consistent with the existing literature, heavy substance use, but not casual or social use, impeded ART uptake, mainly by undermining confidence in medication management abilities and triggering depression. The confluence of African-American/Black or Hispanic race/ethnicity, poverty, and drug use was associated with high levels of perceived stigma and inferior treatment in health-care settings compared to their peers. Furthermore, providers were described as frequently assuming participants were selling their medications to buy drugs, which strained provider–patient relationships. High levels of medical distrust, common in this population, created fears of ART and of negative interactions between street drugs and ART, but participants could not easily discuss this concern with health-care providers. Barriers to ART initiation and HIV care were embedded in other structural- and social-level challenges, which disproportionately affect low-income African-American/Black and Hispanic PLWH (e.g., homelessness, violence). Yet, HIV management was cyclical. In collaboration with trusted providers and ancillary staff, participants commonly reduced substance use and initiated or reinitiated ART. The present study highlights a number of addressable barriers to ART initiation and engagement in HIV care for this vulnerable population, as well as gaps in current practice and potential junctures for intervention efforts.
机译：吸毒与艾滋病毒抗逆转录病毒疗法（ART）的低摄取，艾滋病毒治疗连续性研究不足，以及对艾滋病毒初级保健的参与不足有关。但是，人们对药物滥用阻碍这些HIV健康结果的具体潜在机制知之甚少。当前的定性研究解决了文献中的这一空白，重点关注了艾滋病毒/艾滋病的非洲裔美国人/黑人和西班牙裔人（PLWH），他们延迟，拒绝或终止抗逆转录病毒治疗，并且通常也缺乏医疗保健服务。目的是从一项较大的研究中抽取参与者（N = 37），以最大程度地改变HIV指数。他们在多层次的社会认知理论的指导下，进行了1-2小时的关于艾滋病史的半深度访谈录音。使用系统的内容分析方法分析成绩单。与现有文献一致，使用重物质而不是随意使用或社交会阻碍ART的吸收，这主要是通过削弱对药物管理能力的信心并引发抑郁症。与同龄人相比，非裔美国人/黑人或西班牙裔种族/族裔，贫困和吸毒的融合与在医疗机构中较高的被认为的污名和劣等治疗有关。此外，医疗服务提供者被描述为经常假设参与者出售他们的药物购买药品，这使医疗服务提供者与患者之间的关系紧张。在这一人群中普遍存在的高度医疗不信任感使人们对抗逆转录病毒疗法以及街头毒品与抗逆转录病毒疗法之间的负面相互作用产生了恐惧，但参与者无法轻松地与医疗保健提供者讨论这种担忧。发起抗逆转录病毒疗法和艾滋病毒治疗的障碍还被嵌入到其他结构和社会层面的挑战中，这些挑战对低收入的非裔美国人/黑人和西班牙裔PLWH（例如无家可归，暴力）的影响尤其严重。但是，艾滋病毒的管理是周期性的。与受信任的提供者和辅助人员合作，参与者通常会减少药物的使用，并启动或重新启动抗逆转录病毒疗法。本研究着重指出了在这一脆弱人群中开展抗病毒治疗和参与抗病毒治疗的许多可克服的障碍，以及当前实践中的差距和干预工作的潜在契机。

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