School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom.
PLoS One. 2012;7(5):e35547. doi: 10.1371/journal.pone.0035547. Epub 2012 May 1.
Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal.
A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts.
A total of 282 (85.5%) respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR = 17.99, p = 0.014); alcohol use (OR = 12.89, p = <0.001), being female (OR = 6.91, p = 0.001), being illiterate (OR = 4.58, p = 0.015), side-effects (OR = 6.04, p = 0.025), ART started ≤24 months (OR = 3.18, p = 0.009), travel time to hospital >1 hour (OR = 2.84, p = 0.035). Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription), followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence.
Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients' lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients.
抗逆转录病毒疗法（ART）是治疗人类免疫缺陷病毒（HIV）和获得性免疫缺陷综合征（AIDS）患者的救命稻草。保持对抗逆转录病毒药物的最佳依从性对于 HIV 感染管理至关重要。本研究旨在了解尼泊尔接受 ART 治疗的患者和护理人员的影响因素。
这是一项横断面混合方法研究，调查了 330 名接受 ART 治疗的患者和 34 名深度访谈的利益相关者，包括三种不同类型的利益相关者：患者、护理人员和政策层面的关键人物。通过问卷调查自我报告和访谈来评估依从性。使用多变量逻辑回归模型来确定与依从性相关的因素，并对访谈记录进行主题分析。
共有 282 名（85.5%）受访者报告完全依从，即在接受访谈前四周内没有漏服药物。影响依从性的主要因素包括：HIV 状况未披露（OR=17.99，p=0.014）；饮酒（OR=12.89，p<0.001）、女性（OR=6.91，p=0.001）、文盲（OR=4.58，p=0.015）、副作用（OR=6.04，p=0.025）、ART 开始时间≤24 个月（OR=3.18，p=0.009）、到医院的交通时间>1 小时（OR=2.84，p=0.035）。同样，缺乏对 ART 药物的知识和负面看法也会显著影响不依从。最常见的不依从原因是：交通费用（用于重复处方）、药物用完、不想让别人注意到、副作用和忙碌。访谈还揭示了宗教或仪式障碍、耻辱和歧视、ART 相关费用、交通问题、缺乏支持和副作用是导致不依从的原因。
提高依从性需要一个支持性的环境；可获得的治疗；关于方案的明确说明；以及根据患者的生活方式定制方案。医疗保健工作者应解决 ART 药物治疗方面的一些实际和文化问题，而政策制定者应制定适当的社会政策，以促进接受 ART 治疗的患者的依从性。
