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首页> 外文期刊>AIDS care. >Antiretroviral therapy drug adherence in Rwanda: Perspectives from patients and healthcare workers using a mixed-methods approach
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Antiretroviral therapy drug adherence in Rwanda: Perspectives from patients and healthcare workers using a mixed-methods approach

机译：卢旺达的抗逆转录病毒疗法药物依从性：患者和医护人员使用混合方法的观点

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摘要

Rwanda has achieved high enrollment into antiretroviral therapy (ART) programs but data on adherence after enrollment are not routinely collected. We used a mixed-methods approach (standardized questionnaires, pill counts, focus group discussions, and in-depth interviews) to determine levels of and barriers to ART adherence from the perspective of both patients and healthcare workers (HCW). Data were available from 213 patients throughout the first year on ART; 58 of them and 23 HCW participated in a qualitative sub-study. Self-reported adherence was high (96% of patients reporting more than 95% adherence), but adherence by pill count was significantly lower, especially in the first 3 months. In the standardized interviews, patients mostly reported that they "simply forgot" or "were away from home" as reasons for nonadherence. The qualitative research identified three interrelated constructs that appeared to negatively influence adherence: stigma, difficulty coming to terms with illness, and concealment of illness. Both standardized questionnaires and the qualitative research identified poverty, disruption to daily routines, factors related to regimen complexity and side effects, and service-related factors as barriers to adherence. We conclude that regular triangulation of different sources of adherence data is desirable to arrive at more realistic estimates. We propose that program monitoring and evaluation cycles incorporate more in-depth research to better understand concerns underlying reasons for nonadherence reported in routine monitoring.
机译：卢旺达已成功加入抗逆转录病毒疗法（ART）计划，但并未常规收集入选后依从性的数据。我们使用混合方法（标准化问卷，药丸计数，焦点小组讨论和深入访谈）从患者和医护人员（HCW）的角度确定抗逆转录病毒疗法依从性的水平和障碍。在第一年的抗逆转录病毒治疗中有213名患者获得了数据。其中58名和23名HCW参加了定性子研究。自我报告的依从性很高（96％的患者报告的依从性超过95％），但按药丸计数的依从性显着降低，尤其是在头3个月中。在标准化的访谈中，患者大多报告说他们“只是忘记了”或“出门在外”是不坚持治疗的原因。定性研究确定了三个相互关联的构架，这些构架似乎对依从性产生了负面影响：污名，与疾病相适应的困难以及隐瞒疾病。标准化问卷和定性研究都将贫困，日常工作中断，与方案复杂性和副作用相关的因素以及与服务相关的因素确定为依从性障碍。我们得出结论，需要对不同依从性数据源进行定期三角剖分，以获得更现实的估计。我们建议计划监视和评估周期应进行更深入的研究，以更好地了解常规监视中报告的不遵守原因的根本原因。

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