Department of Behavioral Medicine, St Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA.
J Adolesc Health. 2010 Nov;47(5):504-11. doi: 10.1016/j.jadohealth.2010.03.013. Epub 2010 May 11.
The present study investigated medication adherence in an understudied population, adolescents with behaviorally acquired HIV, to improve upon prior methodological limitations using concurrent collection of HIV health status markers (viral load [VL]; percentage CD4 count [CD4%]) and multimethod adherence assessment (pill count, missed doses, off-schedule dosing).
A total of 60 youth with behaviorally acquired HIV receiving routine care in a multidisciplinary specialty clinic in the Mid-Southern United States. Adherence was assessed by routine pharmacy pill count and self-reported 3-day recall of doses missed and doses taken off-schedule, collected concurrently with clinically obtained VL and CD4% indicators. Adherence measures were evaluated as predictors of VL and CD4% using logistic regression analyses.
Adherence difficulties were detected by all assessment methods, with off-schedule dosing appearing the most problematic (29.4% taken off-schedule). Self-report of doses missed (p = .038) and off-schedule dosing (p = .021) significantly predicted detectable VL. For each percent increase in nonadherence by off-schedule dosing, there was a 2% increased likelihood of detectable VL. No adherence measure significantly correlated with CD4%; pharmacy pill count did not relate to either health status marker.
This study is the first to document multimethod medication adherence measurement in a defined sample of adolescents with behaviorally acquired HIV, using imposed concurrent collection of CD4% and VL. Adherence difficulties were detected regardless of assessment strategy, with off-schedule dosing representing the greatest nonadherence behavior. Both 3-day recall methods predicted VL. Further investigation of adherence in larger samples of youth with behaviorally acquired HIV is needed to better understand the relationship to CD4% suppression.
本研究调查了行为获得性 HIV 的青少年人群中的药物依从性，以改进先前使用 HIV 健康状况标志物（病毒载量 [VL]；CD4 计数百分比 [CD4%]）和多方法依从性评估（药物计数、漏服剂量、不按时服药）同时收集数据的方法学局限性。
共 60 名行为获得性 HIV 的青少年，在美国中南部的一个多学科专业诊所接受常规护理。依从性通过常规药房药物计数和 3 天内漏服和不按时服药的自我报告来评估，同时收集临床获得的 VL 和 CD4%指标。使用逻辑回归分析评估依从性测量结果作为 VL 和 CD4%的预测因子。
所有评估方法均检测到依从性困难，不按时服药问题最为突出（29.4%不按时服药）。漏服剂量的自我报告（p =.038）和不按时服药（p =.021）显著预测 VL 可检测性。不按时服药每增加一个百分点，VL 可检测的可能性就增加 2%。没有任何依从性测量与 CD4%显著相关；药物计数与两个健康状况标志物均无关联。
这项研究首次使用 CD4%和 VL 的同时强制性收集，在明确的行为获得性 HIV 青少年样本中记录了多方法药物依从性测量。无论评估策略如何，都检测到了依从性困难，不按时服药是最大的不依从行为。两种 3 天回顾方法均预测 VL。需要进一步在更大的行为获得性 HIV 青少年样本中研究依从性，以更好地了解其与 CD4%抑制的关系。
