凉山州HIV/AIDS患者抗病毒治疗启动阶段不依从的质性研究

A qualitative study on non-adherence in initiation of antiviral therapy for HIV/AIDS in Liangshan prefecture

目的深入了解四川省凉山州艾滋病病毒(HIV)感染者/艾滋病(AIDS)患者(简称HIV/AIDS患者)抗病毒治疗启动阶段不依从原因,为早日启动抗病毒治疗,提高治疗依从性和有效率提供参考。方法2019年11月至2020年1月,采用现象学研究方法对凉山州23名HIV/AIDS患者进行半结构化深入访谈,运用Colaizzi现象分析法进行资料分析。结果23名受访对象年龄(38±18)岁;男性16人,女性7人;彝族21人,汉族2人;文化水平以小学和文盲为主。提炼出6个抗病毒治疗启动阶段不依从主题:缺乏知识;歧视;不接受感染事实;药物不良反应;消极应对;缺乏信任。结论凉山州HIV/AIDS患者启动阶段抗病毒治疗依从性差有其独特性,主要表现为对艾滋病及抗病毒药物的特殊认知、缺乏信任、消极应对等,艾滋病管理人员在抗病毒治疗启动阶段需重视文化差异,赢得感染者信任,发挥权威人物、同伴教育作用,创新破解低文化群体艾滋病教育、管理难题。

Objective To explore the causes of non-adherence behavior in initiation of antiretroviral therapy(ART)for HIV-infected people in Liangshan prefecture,Sichuan province,and provide a reference for improving their effects and adherence to early initiation of ART.Methods Phenomenological research methods were used to conduct semistructured in-depth interviews with 23 HIV-infected individuals from November 2019 to January 2020,and the data were analyzed by using Colaizzi phenomenon analysis method.Results Twenty-three interviewees were between 38±18 years old.Among them,16 were males and 7 were females.21 were Yi ethnics and 2 Han,and their education levels were mainly primary school or illiterate.There were 6 factors influencing the initiation of ART including lack of AIDS related knowledge,HIV/AIDS stigma,inner rejection,side effects,negative emotions,and lack of trust.Conclusion The poor compliance of HIV-infected persons in Liangshan at the start-up stage of ART is due to lack of AIDS knowledge and ART drugs,lack of trust,and negative emotion,etc.Clinical staff need to pay attention to cultural differences in initiation of ART,win the trust of people living with HIV,play the role of peer educators,and solve the problems of AIDS education and management in low-cultural groups.