Wang Honghong, He Gouping, Li Xianhong, Yang Aiyun, Chen Xi, Fennie Kristopher P, Williams Ann Bartley
School of Nursing, Central South University, Changsha, Hunan, China.
AIDS Patient Care STDS. 2008 Jan;22(1):71-80. doi: 10.1089/apc.2007.0047.
Although the number of patients receiving antiretroviral (ARV) therapy in Central China is expanding, little is known about their medication adherence. The purpose of this study was to: (1) describe adherence prevalence among patients receiving free ARV in south central China; (2) identify factors associated with adherence; (3) compare 3 self-report measures of adherence in this population. A cross-sectional survey was conducted at seven free treatment sites in Hunan, Hubei, and Anhui Provinces. Adherence measures included direct questioning regarding the number of doses taken in the 7 days prior to interview, the Community Programs for Clinical Research on AIDS (CPCRA) Adherence Self-Report questionnaire, and a 7-day visual analogue scale. Subjects comprised all patients returning for monthly ARV follow-up at each site between April and July 2006. Among the 308 subjects, 244 (79%) lived in the countryside. One hundred seventy (55%) had been on ARV over 1 year. No regimen included a protease inhibitor. Two hundred forty-four (80%) reported taking more than 90% of prescribed doses in the previous 7 days. Sixty-four (20%) subjects reported missing at least 1 dose in that period. The three measures of self-reported adherence were highly correlated. On multivariate analysis, current heroin use (odds ratio [OR] = 2.5; 95% confidence interval [CI] 1,6, p = 0.05) and nonuse of reminders such as cell phone alarms, wall charts, or TV programs (OR 6; 95% CI 3, 11; p = 0.001) were associated with 90% or less adherence. Adherence to ARV in Central China is similar to elsewhere in the world. The 20% of subjects who reported taking 90% or fewer doses are of concern in view of the potential for non-nucleoside reverse transcriptase inhibitor resistance and lack of protease inhibitor back-up regimens. Substance abuse treatment will be an essential element of successful AIDS treatment in China. Prospective studies are needed to evaluate the efficacy of reminder devices to improve adherence in this population and to describe the prevalence and incidence of ARV resistance.
尽管中国中部接受抗逆转录病毒（ARV）治疗的患者人数在不断增加，但对他们的用药依从性却知之甚少。本研究的目的是：（1）描述中国中南部接受免费ARV治疗患者的依从性患病率；（2）确定与依从性相关的因素；（3）比较该人群中三种自我报告的依从性测量方法。在湖南、湖北和安徽三省的七个免费治疗点进行了一项横断面调查。依从性测量方法包括直接询问访谈前7天服用的剂量数、艾滋病临床研究社区项目（CPCRA）依从性自我报告问卷以及7天视觉模拟量表。研究对象包括2006年4月至7月期间在每个治疗点每月返回进行ARV随访的所有患者。在308名研究对象中，244名（79%）居住在农村。170名（55%）接受ARV治疗超过1年。没有一种治疗方案包含蛋白酶抑制剂。244名（80%）研究对象报告在过去7天内服用了超过90%的规定剂量。64名（20%）研究对象报告在该期间至少漏服了1剂。三种自我报告的依从性测量方法高度相关。多因素分析显示，目前使用海洛因（比值比[OR]=2.5；95%置信区间[CI]1.6，p=0.05）以及不使用手机闹钟、挂图或电视节目等提醒方式（OR 6；95%CI 3，11；p=0.001）与90%或更低的依从性相关。中国中部地区的ARV治疗依从性与世界其他地区相似。鉴于存在非核苷类逆转录酶抑制剂耐药性的可能性以及缺乏蛋白酶抑制剂备用治疗方案，20%报告服用剂量为90%或更少的研究对象令人担忧。药物滥用治疗将是中国成功治疗艾滋病的一个关键要素。需要进行前瞻性研究，以评估提醒装置提高该人群依从性的效果，并描述ARV耐药性的患病率和发病率。
