Weidle Paul J, Wamai Nafuna, Solberg Peter, Liechty Cheryl, Sendagala Sam, Were Willy, Mermin Jonathan, Buchacz Kate, Behumbiize Prosper, Ransom Ray L, Bunnell Rebecca
Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Lancet. 2006 Nov 4;368(9547):1587-94. doi: 10.1016/S0140-6736(06)69118-6.
Poverty and limited health services in rural Africa present barriers to adherence to antiretroviral therapy that necessitate innovative options other than facility-based methods for delivery and monitoring of such therapy. We assessed adherence to antiretroviral therapy in a cohort of HIV-infected people in a home-based AIDS care programme that provides the therapy and other AIDS care, prevention, and support services in rural Uganda.
HIV-infected individuals with advanced HIV disease or a CD4-cell count of less than 250 cells per muL were eligible for antiretroviral therapy. Adherence interventions included group education, personal adherence plans developed with trained counsellors, a medicine companion, and weekly home delivery of antiretroviral therapy by trained lay field officers. We analysed factors associated with pill count adherence (PCA) of less than 95%, medication possession ratio (MPR) of less than 95%, and HIV viral load of 1000 copies per mL or more at 6 months (second quarter) and 12 months (fourth quarter) of follow-up.
987 adults who had received no previous antiretroviral therapy (median CD4-cell count 124 cells per muL, median viral load 217,000 copies per mL) were enrolled between July, 2003, and May, 2004. PCA of less than 95% was calculated for 0.7-2.6% of participants in any quarter and MPR of less than 95% for 3.3-11.1%. Viral load was below 1000 copies per mL for 894 (98%) of 913 participants in the second quarter and for 860 (96%) of 894 of participants in the fourth quarter. In separate multivariate models, viral load of at least 1000 copies per mL was associated with both PCA below 95% (second quarter odds ratio 10.6 [95% CI 2.45-45.7]; fourth quarter 14.5 [2.51-83.6]) and MPR less than 95% (second quarter 9.44 [3.40-26.2]; fourth quarter 10.5 [4.22-25.9]).
Good adherence and response to antiretroviral therapy can be achieved in a home-based AIDS care programme in a resource-limited rural African setting. Health-care systems must continue to implement, evaluate, and modify interventions to overcome barriers to comprehensive AIDS care programmes, especially the barriers to adherence with antiretroviral therapy.
非洲农村地区的贫困和有限的医疗服务构成了抗逆转录病毒疗法依从性的障碍，这就需要采用除基于医疗机构的方法之外的创新方式来提供和监测此类疗法。我们在乌干达农村一项基于家庭的艾滋病护理项目中，评估了一组感染艾滋病毒者对抗逆转录病毒疗法的依从性，该项目提供这种疗法以及其他艾滋病护理、预防和支持服务。
患有晚期艾滋病毒疾病或CD4细胞计数低于每微升250个细胞的艾滋病毒感染者有资格接受抗逆转录病毒疗法。依从性干预措施包括小组教育、与经过培训的咨询员共同制定的个人依从性计划、一名药物陪伴者，以及由经过培训的非专业现场工作人员每周进行家庭送药的抗逆转录病毒疗法。我们分析了与以下情况相关的因素：随访6个月（第二季度）和12个月（第四季度）时，药丸计数依从性（PCA）低于95%、药物持有率（MPR）低于95%，以及艾滋病毒载量达到每毫升1000拷贝或更高。
2003年7月至2004年5月期间，纳入了987名未曾接受过抗逆转录病毒疗法的成年人（CD4细胞计数中位数为每微升124个细胞，病毒载量中位数为每毫升217,000拷贝）。任何一个季度中，0.7%至2.6%的参与者PCA低于95%，3.3%至11.1%的参与者MPR低于95%。在第二季度的913名参与者中，894名（98%）的病毒载量低于每毫升1000拷贝；在第四季度的894名参与者中，860名（96%）的病毒载量低于每毫升1000拷贝。在单独的多变量模型中，病毒载量至少每毫升1000拷贝与PCA低于95%（第二季度优势比10.6 [95%可信区间2.45 - 45.7]；第四季度14.5 [2.51 - 83.6]）以及MPR低于95%（第二季度9.44 [3.40 - 26.2]；第四季度10.5 [4.22 - 25.9]）均相关。
在资源有限的非洲农村地区基于家庭的艾滋病护理项目中，可以实现对抗逆转录病毒疗法的良好依从性和反应。卫生保健系统必须继续实施、评估和修改干预措施，以克服全面艾滋病护理项目的障碍，尤其是抗逆转录病毒疗法依从性方面的障碍。
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