oa SAHARA : Journal of Social Aspects of HIV / AIDS Research Alliance - Perceived stigma among patients receiving antiretroviral treatment : a prospective randomised trial comparing an m-DOT strategy with standard-of-care in Kenya : original article



HIV and AIDS remain highly stigmatised. Modified directly observed therapy (m-DOT) supports antiretroviral treatment (ART) adherence but little is known about its association with perceived stigma in resource-constrained settings. In 2003, 234 HIV-infected adults enrolled in a two-arm randomised trial comparing a health centre-based m-DOT strategy with standard self-administration of ART. Data on perceived stigma were collected using Berger's HIV stigma scale prior to starting ART and after 12 months. This was a secondary analysis to examine whether perceived stigma was related to treatment delivery. Perceived stigma scores declined after 12 months of treatment from a mean of 44.9 (sd=7.6) to a mean of 41.4 (sd=7.7), (t=6.14, P<0.001). No differences were found between the mean scores of participants in both study arms. Also, no difference in scores was detected using GLM, controlling for socio-demographic characteristics and baseline scores. Findings indicate that a well managed clinic-based m-DOT does not increase perceived HIV-related stigma.

Le VIH et le SIDA restent fortement stigmatises. Le traitement modifie sous surveillance directe (m-DOT) favorise l'adhesion au traitement antiretroviral (ARV) mais il existe peu d'informations sur son association a la stigmatisation percue dans des environnements pauvres en ressources. En 2003, 234 adultes infectes par le VIH etaient inscrits a un essai randomise a deux bras comparant une strategie m-DOT se deroulant dans un centre de sante a une auto-administration standard des ARV. Des donnees sur la stigmatisation percue ont ete collectees en utilisant l'echelle de stigmatisation du VIH de Berger avant d'entamer les ARV puis 12 mois plus tard. Une seconde analyse a ete realisee afin de determiner si la stigmatisation percue etait associee au mode d'administration du traitement. Les resultats de la stigmatisation percue ont baisse au bout de 12 mois de traitement, passant d'une moyenne de 44,9 (σ = 7,7), (t = 6,14, p<0,001) a une moyenne de 41,4 (σ = 7,7), (t = 6,14, p<0,001). Aucune difference n'a ete observe entre les resultats moyens des participants dans les deux branches de l'etude. De plus, aucune difference de resultat n'a ete observee en utilisant le MLG, qui permet de controler les caracteristiques sociodemographiques et les resultats de base. Les conclusions indiquent qu'un m-DOT se deroulant dans un centre medical bien gere n'augmente pas la stigmatisation percue associee au VIH.


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