Gonzalez Jeffrey S, Penedo Frank J, Llabre Maria M, Durán Ron E, Antoni Michael H, Schneiderman Neil, Horne Rob
Harvard Medical School/Massachusetts General Hospital, Department of Psychiatry, Boston 02114, USA.
Ann Behav Med. 2007 Aug;34(1):46-55. doi: 10.1007/BF02879920.
Near-perfect levels of HIV medication adherence are necessary for treatment to be successful. However, many patients continue to report nonadherence to HIV treatment.
This study examines the relationship between symptoms of HIV and medication adherence and evaluates beliefs about HIV medications and negative mood states as potential mediators of this relationship.
These relationships were tested with structural equation modeling using a 15-month longitudinal design. The ethnically diverse convenience sample included 325 HIV-infected men who have sex with men and women prescribed Highly Active Antiretroviral Therapy (HAART).
Results showed that a greater number of symptoms were associated with poorer medication adherence, and this relationship was partially mediated by increases in concerns about HAART. Contrary to expectations, negative mood states were not directly related to medication adherence. In the final model, concerns about HAART and general distrust of medications each predicted poorer HAART adherence. Necessity beliefs about HAART and level of educational attainment each predicted better adherence. The final model accounted for approximately 24% of the variance in HAART adherence.
The results of this study suggest that Horne's (1) necessity-concerns framework can be successfully applied to identify beliefs about medication that are important predictors of adherence to HAART over time. These findings have relevance for developing interventions to improve medication adherence among HIV-infected patients.
要使艾滋病治疗取得成功，接近完美的抗逆转录病毒药物依从性水平是必要的。然而，许多患者仍报告未坚持接受艾滋病治疗。
本研究考察艾滋病症状与药物依从性之间的关系，并评估对艾滋病药物的信念以及负面情绪状态作为这种关系的潜在中介因素。
采用15个月的纵向设计，通过结构方程模型对这些关系进行检验。这个种族多样的便利样本包括325名感染艾滋病的男男性行为者和女性，他们均被开具了高效抗逆转录病毒疗法（HAART）。
结果显示，症状数量越多与药物依从性越差相关，并且这种关系部分由对HAART的担忧增加所介导。与预期相反，负面情绪状态与药物依从性没有直接关系。在最终模型中，对HAART的担忧和对药物的普遍不信任各自都预测了较差的HAART依从性。对HAART的必要性信念和教育程度各自都预测了更好的依从性。最终模型解释了HAART依从性中约24%的方差。
本研究结果表明，霍恩的（1）必要性 - 担忧框架可成功应用于识别对药物的信念，这些信念是长期坚持HAART的重要预测因素。这些发现对于制定干预措施以提高艾滋病感染患者的药物依从性具有重要意义。
