Mugusi F, Mugusi S, Bakari M, Hejdemann B, Josiah R, Janabi M, Aboud S, Aris E, Swai H, Mhalu F, Biberfeld G, Pallangyo K, Sandstrom E
Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Trop Med Int Health. 2009 Oct;14(10):1226-32. doi: 10.1111/j.1365-3156.2009.02359.x. Epub 2009 Sep 3.
To evaluate various strategies aimed at improving adherence to antiretroviral therapy (ART).
Patients initiated on ART at Muhimbili National Hospital HIV clinic were randomly assigned to either regular adherence counseling, regular counseling plus a calendar, or regular counseling and a treatment assistant. Patients were seen monthly; during these meetings self-reported adherence to treatment was recorded. Disease progression was monitored clinically and immunologically.
Of the 621 patients randomized, 312 received regular counseling only, 242 regular counseling and calendars, while 67 had treatment assistants in addition to regular counseling. The mean (SD) follow-up time was 14.5 (4.6) months. During follow-up 20 (3.2%) patients died, and 102 (16.4%) were lost to follow-up; this was similar in all groups. In 94.8% of all visits, patients reported to have adhered to treatment. In only 39 (0.7%) visits did patients report a < or = 95% adherence. There were no differences in adherence (P = 0.573) or differences in CD4 count and weight changes over time in the interventions.
Good adherence to ART is possible in resource constrained countries. Persistent adherence counseling in clinic settings by itself may be effective in improving adherence to ART.
评估旨在提高抗逆转录病毒治疗（ART）依从性的各种策略。
在穆希姆比利国家医院艾滋病诊所开始接受抗逆转录病毒治疗的患者被随机分为三组，分别接受常规依从性咨询、常规咨询加日历或常规咨询和治疗助手。患者每月就诊一次；在这些就诊期间，记录患者自我报告的治疗依从性。临床和免疫学监测疾病进展。
在621名随机分组的患者中，312名仅接受常规咨询，242名接受常规咨询和日历，67名除常规咨询外还有治疗助手。平均（标准差）随访时间为14.5（4.6）个月。随访期间，20名（3.2%）患者死亡，102名（16.4%）失访；所有组情况相似。在94.8%的就诊中，患者报告坚持治疗。仅在39次（0.7%）就诊中，患者报告依从性<或=95%。干预措施在依从性方面（P = 0.573）以及CD4细胞计数和体重随时间变化方面均无差异。
在资源有限的国家，良好的抗逆转录病毒治疗依从性是可能的。在临床环境中持续进行依从性咨询本身可能有助于提高抗逆转录病毒治疗的依从性。
