Johnson Mallory O, Chesney Margaret A, Goldstein Rise B, Remien Robert H, Catz Sheryl, Gore-Felton Cheryl, Charlebois Edwin, Morin Stephen F
Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California 94105, USA.
AIDS Patient Care STDS. 2006 Apr;20(4):258-68. doi: 10.1089/apc.2006.20.258.
Adherence to antiretroviral (ARV) therapy for HIV infection is critical for maximum benefit from treatment and for the prevention of HIV-related complications. There is evidence that many factors determine medication adherence, including adherence self-efficacy (confidence in one's ability to adhere) and relations with health care providers. However, there are no studies that examine how these two factors relate to each other and their subsequent influence on HIV medication adherence. The goal of the current analysis was to explore a model of medication adherence in which the relationship between positive provider interactions and adherence is mediated by adherence self-efficacy. Computerized self-administered and interviewer-administered self reported measures of medication adherence, demographic and treatment variables, provider interactions, and adherence self-efficacy were administered to 2765 HIV-infected adults on ARV. Criteria for mediation were met, supporting a model in which adherence self-efficacy is the mechanism for the relationship between positive provider interactions and adherence. The finding was consistent when the sample was stratified by gender, race, injection drug use history, and whether the participant reported receipt of HIV specialty care. Positive provider interactions may foster greater adherence self-efficacy, which is associated with better adherence to medications. Results suggest implications for improving provider interactions in clinical care, and future directions for clarifying interrelationships among provider interactions, adherence self-efficacy, and medication adherence are supported.
坚持接受抗逆转录病毒（ARV）治疗对于有效控制HIV感染、预防HIV相关并发症至关重要。有证据表明，许多因素决定了药物依从性，包括依从性自我效能感（对自身坚持服药能力的信心）以及与医疗服务提供者的关系。然而，尚无研究探讨这两个因素如何相互关联以及它们随后对HIV药物依从性的影响。当前分析的目的是探索一种药物依从性模型，其中积极的医患互动与依从性之间的关系由依从性自我效能感介导。对2765名接受ARV治疗的HIV感染成人进行了计算机化自我管理和访谈者管理的自我报告药物依从性、人口统计学和治疗变量、医患互动以及依从性自我效能感的测量。满足了中介标准，支持了一种模型，即依从性自我效能感是积极的医患互动与依从性之间关系的机制。当按性别、种族、注射吸毒史以及参与者是否报告接受过HIV专科护理对样本进行分层时，该发现是一致的。积极的医患互动可能会增强依从性自我效能感，而这与更好的药物依从性相关。结果表明了改善临床护理中医患互动的意义，并支持了未来阐明医患互动、依从性自我效能感和药物依从性之间相互关系的研究方向。
