温哥华注射吸毒者中高效抗逆转录病毒治疗依从性的社会心理决定因素

Psychosocial determinants of adherence to highly active antiretroviral therapy among injection drug users in Vancouver.

作者信息

Kerr Thomas, Palepu Anita, Barness Gordon, Walsh John, Hogg Robert, Montaner Julio, Tyndall Mark, Wood Evan

机构信息

Canadian HIV/AIDS Legal Network, Montreal, Que., Canada.

出版信息

Antivir Ther. 2004 Jun;9(3):407-14.

PMID:15259903

Abstract

BACKGROUND

Sub-optimal adherence to highly active antiretroviral therapy (HAART) among injection drug users (IDUs) is a significant concern. As such, there is an urgent need to identify psychosocial determinants of adherence that can be incorporated into interventions designed to promote optimal adherence.

OBJECTIVE

To identify psychosocial determinants of adherence to HAART, as well as self-reported reasons for missing doses of HAART among HIV-infected IDUs.

METHODS

We developed an eight-item adherence self-efficacy scale comprised of two sub-scales: adherence efficacy and self-regulatory efficacy. We examined correlates between adherence self-efficacy, outcome expectations, socio-demographic characteristics, drug use and risk behaviours, social support and HAART adherence among 108 HIV-infected participants in the Vancouver Injection Drug Users Study (VIDUS). Pharmacy-based adherence to HAART was obtained through a confidential record linkage to the province of British Columbia's HIV/AIDS Drug Treatment Program. Participants were defined as adherent if they picked-up 95% of their HAART prescriptions. Participants were also asked to indicate reasons for missing doses of HAART. Logistic regression was used to identify the factors independently associated with adherence to HAART.

RESULTS

Seventy-one (66%) HIV-infected IDUs were less than 95% adherent. Forgetting was the most frequently cited reason (27%) for missing doses of HAART. Factors independently associated with adherence to HAART included adherence efficacy expectations [OR=1.8 (95% CI: 1.0-3.1); P=0.039] and negative outcome expectations [OR=0.8 (95% CI: 0.7-0.9); P=0.027].

CONCLUSIONS

We found low rates of adherence to HAART among IDUs. Psychological constructs derived from self-efficacy theory are highly germane to the understanding of adherence behaviour, and interventions that address these constructs should be developed and tested among HIV-infected drug users.

摘要

背景

注射吸毒者（IDU）对高效抗逆转录病毒疗法（HAART）的依从性欠佳是一个重大问题。因此，迫切需要确定依从性的心理社会决定因素，以便将其纳入旨在促进最佳依从性的干预措施中。

目的

确定HIV感染的注射吸毒者对HAART依从性的心理社会决定因素，以及自我报告的漏服HAART剂量的原因。

方法

我们开发了一个由八个项目组成的依从性自我效能量表，该量表由两个子量表组成：依从性效能和自我调节效能。我们在温哥华注射吸毒者研究（VIDUS）中的108名HIV感染参与者中，研究了依从性自我效能、结果期望、社会人口学特征、药物使用和风险行为、社会支持与HAART依从性之间的相关性。通过与不列颠哥伦比亚省HIV/艾滋病药物治疗项目的保密记录链接，获取基于药房的HAART依从性数据。如果参与者领取了95%的HAART处方，则被定义为依从者。参与者还被要求指出漏服HAART剂量的原因。使用逻辑回归来确定与HAART依从性独立相关的因素。

结果

71名（66%）HIV感染的注射吸毒者依从性低于95%。忘记是漏服HAART剂量最常被提及的原因（27%）。与HAART依从性独立相关的因素包括依从性效能期望[比值比（OR）=1.8（95%置信区间：1.0 - 3.1）；P = 0.039]和负面结果期望[OR = 0.8（95%置信区间：0.7 - 0.9）；P = 0.027]。