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ART Adherence among Adolescents & Young People Living with HIV in Southern Malawi: A Conditional Process Analysis

機(jī)譯：馬拉維南部青少年艾滋病毒攜帶者中的ART依從性：條件過(guò)程分析

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Adherence to antiretroviral therapy (ART) leads to achievement and maintenance of durable viral suppression. Viral suppression ensures immune reconstitution, decreased morbidity and mortality. However, youths living with HIV are particularly challenged to adhere to ART due to various factors associated with their developmental trajectory. This cross-sectional study (1) examined the rate of ART adherence and virological non-suppression, (2) validated three ART adherence measures: pill count, Likert scale and visual analogue scale to determine how well they could identify virally unsuppressed youths, (3) explored correlates of viral non-suppression, and (4) examined the interactive mechanisms through which depression, HIV-related stigma, self-efficacy, and gender influence ART adherence among 450 youths (13--24 years) engaged in care and treatment in public health facilities in Blantyre, Zomba, Mwanza, Mangochi, Chikwawa and Chiradzulu in southern Malawi.;Viral non-suppression and its correlates were examined among 209 youths for whom a viral load (VL) within the 60 days preceding the day of the interview was available. Viral non-suppression was defined as HIV RNA >1,000 copies/ml. Findings showed that 81 (39%) were virally non-suppressed. Male gender and stigma were independently associated with VL non-suppression, while social support and self-efficacy were independently protective of VL non-nonsuppression. Of the three adherence measures, pill count had the highest positive predictive value (66.3%) followed by the Likert scale (48.2%) while the visual analogue scale (VAS) came last (45.16%). Using Pill count at <80% nonadherence cutoff point, 36 (17.2%) of the youth were nonadherent. Of those who were adherent, just 120 (69.4%) were VL suppressed.;Guided by Social Action Theory (SAT), a conditional process analysis revealed that gender moderated both the direct and indirect effects of depression and stigma via self-efficacy on ART adherence. Furthermore, self-efficacy simultaneously mediated and moderated the relationship between stigma and ART adherence.;This study revealed high rates of ART nonadherence and virological non-suppression. It also highlighted various key factors that affected ART adherence among youths in southern Malawi. Interventions should aim at reducing the impact of stigma and bolster social support and self-efficacy while taking into account gender in their design and implementation.
機(jī)譯：堅(jiān)持抗逆轉(zhuǎn)錄病毒療法（ART）可以實(shí)現(xiàn)并維持持久的病毒抑制作用。病毒抑制可確保免疫重建，降低發(fā)病率和死亡率。但是，由于與他們的發(fā)展軌跡相關(guān)的各種因素，艾滋病毒感染者尤其面臨堅(jiān)持抗逆轉(zhuǎn)錄病毒療法的挑戰(zhàn)。這項(xiàng)橫斷面研究（1）檢查了ART依從性和病毒學(xué)非抑制率，（2）驗(yàn)證了三種ART依從性措施：藥丸計(jì)數(shù)，李克特量表和視覺模擬量表，以確定他們?nèi)绾魏芎玫刈R(shí)別未受到病毒抑制的年輕人，（ 3）探索了病毒非抑制的相關(guān)性，并且（4）研究了相互作用的機(jī)制，通過(guò)該機(jī)制，抑郁癥，HIV相關(guān)的恥辱感，自我效能感和性別影響了從事護(hù)理和治療的450名年輕人（13--24歲）的抗逆轉(zhuǎn)錄病毒依從性。馬拉維南部布蘭太爾，宗巴，姆萬(wàn)扎，曼果池，奇瓦瓦和奇拉祖魯?shù)墓残l(wèi)生設(shè)施進(jìn)行治療;在前一天的60天之內(nèi)的209名病毒載量（VL）青年中檢查了病毒非抑制及其相關(guān)性面試可用。病毒非抑制定義為HIV RNA> 1,000拷貝/ ml。調(diào)查結(jié)果顯示，有81位（39％）的病毒不受抑制。男性和恥辱與VL不抑制獨(dú)立相關(guān)，而社會(huì)支持和自我效能感則對(duì)VL不抑制獨(dú)立保護(hù)。在這三種依從性措施中，藥丸計(jì)數(shù)的陽(yáng)性預(yù)測(cè)值最高（66.3％），其次是李克特量表（48.2％），而視覺模擬量表（VAS）位居最后（45.16％）。使用非依從性截止點(diǎn)＜80％的藥丸計(jì)數(shù)，有36名（17.2％）的青年人未依從。在依從性患者中，只有120（69.4％）被VL抑制。；在社會(huì)行為理論（SAT）的指導(dǎo)下，條件過(guò)程分析顯示，性別通過(guò)自我效能對(duì)ART的影響減輕了抑郁和污名的直接和間接影響堅(jiān)持。此外，自我效能感同時(shí)介導(dǎo)和緩解了恥辱感與抗逆轉(zhuǎn)錄病毒依從性之間的關(guān)系。這項(xiàng)研究表明，抗逆轉(zhuǎn)錄病毒療法與抗病毒藥物的抑制率很高。它還強(qiáng)調(diào)了影響馬拉維南部青年人接受抗逆轉(zhuǎn)錄病毒療法的各種關(guān)鍵因素。干預(yù)措施的目的應(yīng)是減少污名化的影響，增強(qiáng)社會(huì)支持和自我效能，同時(shí)在設(shè)計(jì)和實(shí)施過(guò)程中考慮性別因素。

著錄項(xiàng)

  • 作者

    Umar, Eric.;

  • 作者單位

    University of Illinois at Chicago.;

  • 授予單位 University of Illinois at Chicago.;
  • 學(xué)科 Public health.;Mental health.;Behavioral psychology.
  • 學(xué)位 Ph.D.
  • 年度 2017
  • 頁(yè)碼 116 p.
  • 總頁(yè)數(shù) 116
  • 原文格式 PDF
  • 正文語(yǔ)種 eng
  • 中圖分類 遙感技術(shù);
  • 關(guān)鍵詞

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