Personal barriers to antiretroviral therapy adherence: case studies from a rural Uganda prospective clinical cohort.

BACKGROUND Although good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes, some patients may have specific personal barriers to ART adherence. OBJECTIVES To study specific personal barriers to ART adherence. METHODS Quantitative data on patients' health status, ART adherence, CD4 cell counts and viral loads were collected, and qualitative data on life experiences of five patients with poor ART outcomes and adherence were also collected. RESULTS Out of 35 patients with poor immunological and virological ART outcomes, 17 (49%) also had poor ART adherence. Patient 1 had no living child and did not disclose her HIV serostatus to her spouse because she wanted to have a child. Patient 2 was an orphan with neither social nor family support. Patient 3 stopped ART when she conceived, returned to the study clinic when pregnant again and was sickly. She was switched to second-line ART with satisfactory outcomes. Patient 4, a 14 year old orphan had missed ART for 2 months when his treatment supporter was away. Patient 5 aged 66 years stopped ART which he blamed for his erectile dysfunction. CONCLUSION ART adherence counselling should target specific personal barriers to ART adherence like: lack of family support, health and sexual life concerns, desire to have children and family instability.

背景 尽管良好的抗逆转录病毒疗法（ART）依从性对治疗取得成功至关重要，但一些患者在坚持ART治疗方面可能存在特定的个人障碍。 目的 研究坚持抗逆转录病毒疗法的特定个人障碍。 方法 收集了有关患者健康状况、抗逆转录病毒疗法依从性、CD4细胞计数和病毒载量的定量数据，还收集了5名抗逆转录病毒疗法治疗效果和依从性不佳患者的生活经历的定性数据。 结果 在35名免疫和病毒学抗逆转录病毒疗法治疗效果不佳的患者中，17人（49%）抗逆转录病毒疗法依从性也较差。患者1没有存活的孩子，并且因为她想要孩子而没有向配偶透露自己的艾滋病病毒血清状况。患者2是孤儿，没有社会或家庭支持。患者3在怀孕时停止了抗逆转录病毒疗法，再次怀孕且生病时回到研究诊所。她改用二线抗逆转录病毒疗法并取得了满意的效果。患者4是一名14岁的孤儿，在其治疗支持者离开时漏服抗逆转录病毒疗法药物2个月。患者5年龄为66岁，因认为抗逆转录病毒疗法导致其勃起功能障碍而停止治疗。 结论 抗逆转录病毒疗法依从性咨询应针对坚持抗逆转录病毒疗法的特定个人障碍，例如：缺乏家庭支持、健康和性生活方面的担忧、生育愿望以及家庭不稳定。