No abstract

Antiretroviral therapy (ART) started to become more widely available in Vietnam in 2005. However, up to now, very little is known about factors influencing ART adherence among people living with HIV (PLHIV) in Vietnam. This qualitative study aimed to describe factors influencing ART adherence among PLHIV in a northern province in Vietnam, and to explore possibilities of home delivery of ART. Forty-eight participants (36 men and 12 women), including patients on ART and their relatives, were divided in seven focus group discussions. The topics discussed included: adherence obstacles encountered during ART, methods patients used to enhance adherence, treatment support structures, and attitudes toward home delivery of ART. All interviews were audio-recorded, then transcribed in Vietnamese. Manual manifest and latent content analysis was applied for data analysis in order to elucidate the presence of, meaning of, and relationships between concepts in the text. Stigma was identified as a strong barrier to ART adherence, as patients feared that taking medications in the presence of other persons would lead to suspicion or inadvertent disclosure of their HIV status. In addition to desires for non-disclosure influencing PLHIV's adherence, it also shaped their attitudes toward opting for more confidential ways of receiving ART support and care. Home delivery of ART medications was seen as undesirable by participants, who feared that it might increase social stigmatization. Participants wished for more community-based support, preferably from PLHIV who had received sufficient training. Based on the results of this study, an intervention strategy using PLHIV as community-based adherence supporters is currently being evaluated in a randomized controlled trial intervention, including 640 patients in Quang Ninh, Vietnam.

BackgroundAmong people living with HIV (PLHIV) on antiretroviral therapy (ART), it is important to determine how quality of life (QOL) may be improved and HIV-related stigma can be lessened over time. This study assessed the effect of peer support on QOL and internal stigma during the first year after initiating ART among a cohort of PLHIV in north-eastern Vietnam.MethodsA sub-sample study of a randomised controlled trial was implemented between October 2008 and November 2010 in Quang Ninh, Vietnam. In the intervention group, participants (n = 119) received adherence support from trained peer supporters who visited participants’ houses biweekly during the first two months, thereafter weekly. In the control group, participants (n = 109) were treated according to standard guidelines, including adherence counselling, monthly health check and drug refills. Basic demographics were measured at baseline. QOL and internal stigma were measured using a Vietnamese version of the WHOQOL-HIVBREF and Internal AIDS-related Stigma Scale instruments at baseline and 12 months. T-tests were used to detect the differences between mean values, multilevel linear regressions to determine factors influencing QOL.ResultsOverall, QOL improved significantly in the intervention group compared to the control group. Among participants initiating ART at clinical stages 3 and 4, education at high school level or above and having experiences of a family member dying from HIV were also associated with higher reported QOL. Among participants at clinical stage 1 and 2, there was no significant effect of peer support, whereas having children was associated with an increased QOL. Viral hepatitis was associated with a decreased QOL in both groups. Lower perceived stigma correlated significantly but weakly with improved QOL, however, there was no significant relation to peer support.ConclusionThe peer support intervention improved QOL after 12 months among ART patients presenting at clinical stages 3 and 4 at baseline, but it had no impact on QOL among ART patients enrolled at clinical stages 1 and 2. The intervention did not have an effect on Internal AIDS-related stigma. To improve QOL for PLHIV on ART, measures to support adherence should be contextualized in accordance with individual clinical and social needs.