Simoni Jane M, Frick Pamela A, Pantalone David W, Turner Barbara J
Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195, USA.
Top HIV Med. 2003 Nov-Dec;11(6):185-98.
Adherence has proven to be Achilles' heel of antiretroviral therapy. To achieve the nearly perfect adherence apparently necessary for optimal effects, individuals often require assistance. In this review, we examine antiretroviral therapy adherence intervention studies and reviews published through January 2003 as well as abstracts of ongoing National Institutes of Health-funded research projects aimed at enhancing antiretroviral therapy adherence. The 21 published studies we located utilized 4 intervention strategies: cognitive-behavioral, behavioral, directly observed therapy, and affective. Most of these were pilot or feasibility studies. However, the 4 randomized controlled trials conducted with adequate methologic rigor suggest some promising yet preliminary effects of a pharmacist-led individualized intervention, a cognitive-behavioral educational intervention based on self-efficacy theory, and cue-dose training when combined with monetary reinforcement. The 39 ongoing federally funded studies offer superior methodologic sophistication and include some innovative strategies, such as the use of handheld devices, two-way pagers, and alarmed medication vials, along with enhancement of social and emotional support.
坚持服药已被证明是抗逆转录病毒疗法的致命弱点。为了实现最佳疗效显然所需的近乎完美的服药依从性，患者通常需要得到帮助。在本综述中，我们研究了截至2003年1月发表的抗逆转录病毒疗法依从性干预研究和综述，以及美国国立卫生研究院资助的旨在提高抗逆转录病毒疗法依从性的正在进行的研究项目的摘要。我们找到的21项已发表研究采用了4种干预策略：认知行为、行为、直接观察疗法和情感干预。其中大多数是试点或可行性研究。然而，4项进行得具有足够方法学严谨性的随机对照试验表明，由药剂师主导的个体化干预、基于自我效能理论的认知行为教育干预以及与金钱强化相结合的提示剂量训练具有一些有前景但初步的效果。39项正在进行的联邦资助研究具有更高的方法学复杂性，包括一些创新策略，如使用手持设备、双向传呼机和带警报的药瓶，以及加强社会和情感支持。
