云南省文山州HIV感染者抗病毒治疗脱失影响因素的定性研究

Qualitative study of factors associated with antiretroviral therapy drop-out among HIV-infected patients in Wenshan prefecture,Yunnan Province

目的了解云南省文山州人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者抗病毒治疗(antiretroviral therapy,ART)脱失的影响因素。方法根据"研究对象最大差异"原则,采用立意抽样的方法从文山州文山市和马关县的三个ART门诊选取ART脱失者、脱失者家属、ART工作人员进行深入定性访谈,从个人、家庭、门诊三个层面探讨ART脱失的影响因素,样本量根据信息饱和原则确定。结果本次共访谈43名ART脱失者,平均年龄为(47.8±15.6)岁;还访谈了7名脱失者家属和11名ART工作人员。结果显示,药物副反应、对ART认知不正确、担心暴露、歧视、服药心理负担大、采用偏方替代治疗是个人层面影响治疗脱失的因素,家庭支持、ART可及性、门诊医疗服务水平是影响治疗脱失的外部因素。结论影响文山州HIV感染者ART脱失的因素包括药物副反应、ART认知、心理因素、家庭支持、门诊服务水平和ART可及性,应从个人、家庭和门诊层面采取综合干预措施降低治疗脱失。

Objective To assess factors associated with antiretroviral therapy（ ART） drop-out among human immunodeficiency virus（ HIV）-infected patients in Wenshan prefecture,Yunnan Province. Methods Patients who discontinued ART,family members of patients who discontinued ART,and ART providers were recruited by purposive sampling from 3 ART clinics in Wenshan and Maguan counties according to the principle of maximum difference of subjects and sample size was determined by saturation,face to face in-depth interview was used to explore factors associated with ART dropout on personal level,family level and clinic level. Results After an in-depth interview of 43 patients who discontinued ART,aged（ 47. 8 ± 15. 6） years,and 7 family members of patients who discontinued ART and 11 ART providers,we found that side effect,lack of cognition about ART,fear of exposure,stigma,psychological burden about ART,opting for alternative treatment were influential factors for personal level associated with ART drop-out; support from family,accessibility of ART and service in ART clinic were exterior factors influencing ART drop-out. Conclusions Factors for ART drop-out among HIV-infected patients in Wenshan prefecture are multifaceted,thus,comprehensive intervention strategies on personal,family and clinic levels should be taken to reduce ART drop-out.