Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston MA, USA.
BMC Health Serv Res. 2010 Feb 19;10:42. doi: 10.1186/1472-6963-10-42.
Access to antiretroviral therapy has dramatically expanded in Africa in recent years, but there are no validated approaches to measure treatment adherence in these settings.
In 16 health facilities, we observed a retrospective cohort of patients initiating antiretroviral therapy. We constructed eight indicators of adherence and visit attendance during the first 18 months of treatment from data in clinic and pharmacy records and attendance logs. We measured the correlation among these measures and assessed how well each predicted changes in weight and CD4 count.
We followed 488 patients; 63.5% had 100% coverage of medicines during follow-up; 2.7% experienced a 30-day gap in treatment; 72.6% self-reported perfect adherence in all clinic visits; and 19.9% missed multiple clinic visits. After six months of treatment, mean weight gain was 3.9 kg and mean increase in CD4 count was 138.1 cells/mm3.Dispensing-based adherence, self-reported adherence, and consistent visit attendance were highly correlated. The first two types of adherence measure predicted gains in weight and CD4 count; consistent visit attendance was associated only with weight gain.
This study demonstrates that routine data in African health facilities can be used to monitor antiretroviral adherence at the patient and system level.
近年来，抗逆转录病毒疗法在非洲的可及性显著扩大，但在这些环境中，尚无经过验证的方法来衡量治疗依从性。
在 16 家卫生机构中，我们观察了一个开始接受抗逆转录病毒治疗的回顾性队列患者。我们从诊所和药房记录以及出勤记录中构建了治疗开始后 18 个月内的 8 个依从性和就诊出勤率指标。我们测量了这些措施之间的相关性，并评估了每种措施预测体重和 CD4 计数变化的能力。
我们随访了 488 名患者；63.5%的患者在随访期间有 100%的药物覆盖率；2.7%的患者经历了 30 天的治疗中断；72.6%的患者在所有就诊时报告完全依从；19.9%的患者错过了多次就诊。治疗六个月后，平均体重增加 3.9 公斤，CD4 计数平均增加 138.1 个细胞/mm3。基于配药的依从性、自我报告的依从性和一致的就诊出勤率高度相关。前两种类型的依从性测量可以预测体重和 CD4 计数的增加；一致的就诊出勤率仅与体重增加有关。
本研究表明，非洲卫生机构的常规数据可用于监测患者和系统层面的抗逆转录病毒治疗依从性。
