title: High levels of psychosocial readiness for ART in an African population at the onset of treatment.
abstract: Adherence at the earliest stages of treatment is likely to be influenced by prior illness trajectories and future expectations, best captured (and addressed) before treatment begins. We examined the influence of illness trajectories and treatment expectations on psychosocial readiness to start antiretroviral therapy (ART) in Jinja, Uganda. In-depth interviews were conducted between October 2005 and April 2006 with 41 members of an AIDS support organisation on their first day of treatment. Transcribed texts were translated, coded and analysed thematically using NVIVO-7 software. Results indicated that acute fear of death and progressive withdrawal from social, economic and sexual roles narrowed focus on survival, while efficacy-enhancing experiences with septrin prophylaxis and trust in counsellors reinforced belief in HIV diagnosis and importance of adherence. Most enjoyed supportive home environments after disclosing their serostatus. Lack of money for food and transport was anticipated as the main barriers to future adherence, particularly among women. Integrating strong counselling support with ART provision helped channel the power of shared illness experience into positive motivation to adhere at the onset of treatment.
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS. brent.wolff@mrcuganda.org
authors.forename: Brent
authors.initials: B
authors.lastname: Wolff
authors.forename: Martin
authors.initials: M
authors.lastname: Mbonye
authors.forename: Aartin
authors.initials: A
authors.lastname: Coutinho
authors.forename: Barbara
authors.initials: B
authors.lastname: Amuron
authors.forename: Robert
authors.initials: R
authors.lastname: Nkabala
authors.forename: Shabbar
authors.initials: S
authors.lastname: Jaffar
authors.forename: Heiner
authors.initials: H
authors.lastname: Grosskurth
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009042:Motivation; D011203:Poverty; D011287:Prejudice; D011369:Professional-Patient Relations; D012189:Retrospective Studies; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology; D011795:Surveys and Questionnaires; D014454:Uganda
chemical_list: D019380:Anti-HIV Agents