Maqutu Dikokole, Zewotir Temesgen
School of Statistics and Actuarial Science, University of KwaZulu-Natal, Pietermaritzburg Campus, South Africa.
AIDS Care. 2011 Nov;23(11):1417-24. doi: 10.1080/09540121.2011.565028. Epub 2011 Jul 18.
We aimed to investigate the determinants of optimal highly active antiretroviral therapy (HAART) adherence and time interval between successive clinic visits, and the association between these two processes. This was done by reviewing routinely collected patient information in the Centre for the AIDS Programme of Research in South Africa (CAPRISA). Records of 688 patients enrolled in the CAPRISA AIDS treatment (CAT) programme between 2004 and 2006 were analysed. Patients were considered adherent if they had taken at least 95% of their prescribed drugs. The adherence has been measured using the pill counts data. A multivariate generalised mixed random effects approach was used to jointly analyse optimal HAART adherence and time interval between successive visits. The results showed that on the overall, the association between optimal HAART adherence and time interval between successive visits was negative. The results further showed that the interaction between time and treatment site had a significant joint effect on optimal HAART adherence and time interval between successive visits. The interaction revealed that as the number of follow-up visits increased, the interval between successive visits also increased while at the same time high levels of optimal adherence were maintained in the rural treatment site. Moreover, after accounting for the time interval between successive visits, the results showed that optimal HAART adherence was significantly associated with having a cell phone, living with a partner as well as interactions that include time and gender, time and treatment site, age and gender and age and education. The findings provide evidence of a negative association between optimal HAART adherence and the time interval between successive clinic visits on the overall, which therefore indicates that longer time interval between successive clinic visits is undesirable if optimal HAART adherence is to be maintained. This notwithstanding, rural patients were able to maintain HAART adherence for longer time interval between successive clinic visits. Furthermore, the findings indicated that optimal HAART adherence was low for some sub-populations, such as the urban and male populations, thus vigorous ongoing adherence counseling is required.
我们旨在调查高效抗逆转录病毒疗法（HAART）最佳依从性的决定因素、连续两次门诊就诊之间的时间间隔，以及这两个过程之间的关联。这是通过回顾南非艾滋病研究项目中心（CAPRISA）定期收集的患者信息来完成的。对2004年至2006年期间纳入CAPRISA艾滋病治疗（CAT）项目的688名患者的记录进行了分析。如果患者服用了至少95%的处方药，则被视为依从。依从性通过药丸计数数据进行测量。采用多变量广义混合随机效应方法，对HAART的最佳依从性和连续就诊之间的时间间隔进行联合分析。结果表明，总体而言，HAART的最佳依从性与连续就诊之间的时间间隔呈负相关。结果还表明，时间与治疗地点之间的相互作用对HAART的最佳依从性和连续就诊之间的时间间隔具有显著的联合效应。这种相互作用表明，随着随访就诊次数的增加，连续就诊之间的间隔也会增加，同时农村治疗地点保持了高水平的最佳依从性。此外，在考虑了连续就诊之间的时间间隔后，结果表明，HAART的最佳依从性与拥有手机、与伴侣同住以及包括时间与性别、时间与治疗地点、年龄与性别以及年龄与教育程度之间的相互作用显著相关。研究结果提供了证据，总体上表明HAART的最佳依从性与连续门诊就诊之间的时间间隔呈负相关，因此这表明，如果要维持HAART的最佳依从性，则连续门诊就诊之间较长的时间间隔是不可取的。尽管如此，农村患者在连续门诊就诊之间能够保持较长时间的HAART依从性。此外，研究结果表明，某些亚人群，如城市人群和男性人群，HAART的最佳依从性较低，因此需要持续进行积极的依从性咨询。
