Brown Jennifer L, Littlewood Rae A, Vanable Peter A
a Department of Behavioral Sciences and Health Education , Emory University , Atlanta , GA , USA.
AIDS Care. 2013;25(9):1149-58. doi: 10.1080/09540121.2012.752566. Epub 2013 Jan 11.
High levels of antiretroviral therapy (ART) adherence are required to achieve optimal viral suppression. To better understand mechanisms associated with ART adherence, this study characterized demographic and social-cognitive correlates of ART adherence among HIV-infected individuals from a medium-sized northeastern US city (n=116; 42% female; 43% African-American). Participants completed an audio computer-assisted self-interviewing survey assessing demographics, social-cognitive constructs, and ART adherence, and the participants' most recent viral load was obtained from their medical charts. Suboptimal ART adherence (taking less than 95% of prescribed medications during the past month) was reported by 39% of participants and was associated with being female, being a minority, and having a detectable viral load. In a hierarchical logistic regression analysis, greater than 95% ART adherence was associated with higher levels of adherence self-efficacy (AOR =1.1; p=0.015), higher perceived normative beliefs about the importance of ART adherence (AOR=1.3; p=0.03), and lower concern about missing ART doses (AOR=0.63; p=0.002). Adherence did not differ based on ART outcome expectancies, ART attitudes, or the perceived necessity of ART. In fact, most participants endorsed positive attitudes and expectancies regarding the need for and effectiveness of ART. Taken together, results indicate that suboptimal adherence remains high among HIV-infected minority women, a subpopulation that experiences particularly high rates of chronic stress due to both illness-specific stressors and broader environmental stressors. Consistent with social-cognitive theory, adherence problems in our sample were linked with deficits in self-efficacy as well as perceived norms and behavioral intentions that do not support a goal of 100% adherence. We suggest that interventions to improve adherence informed by social-cognitive theory (1) target patients who are at risk for adherence problems, (2) provide a supportive environment that promotes high rates of adherence, and (3) address inaccurate beliefs regarding optimal adherence levels.
为实现最佳的病毒抑制效果，需要高水平的抗逆转录病毒疗法（ART）依从性。为了更好地理解与ART依从性相关的机制，本研究对来自美国东北部一个中等规模城市的HIV感染者（n = 116；42%为女性；43%为非裔美国人）中ART依从性的人口统计学和社会认知相关因素进行了特征分析。参与者完成了一项音频计算机辅助自我访谈调查，评估人口统计学、社会认知结构和ART依从性，并从他们的病历中获取参与者最近的病毒载量。39%的参与者报告ART依从性欠佳（在过去一个月内服用的规定药物少于95%），这与女性、少数族裔以及可检测到病毒载量有关。在分层逻辑回归分析中，高于95%的ART依从性与更高水平的依从自我效能感（优势比[AOR]=1.1；p = 0.015）、对ART依从性重要性的更高感知规范信念（AOR = 1.3；p = 0.03）以及对漏服ART剂量的更低担忧（AOR = 0.63；p = 0.002）相关。依从性在ART结果期望、ART态度或对ART的感知必要性方面没有差异。事实上，大多数参与者对ART的必要性和有效性持积极态度和期望。综上所述，结果表明，HIV感染的少数族裔女性中欠佳依从性仍然很高，这一亚群体由于疾病特异性应激源和更广泛的环境应激源而经历特别高的慢性应激率。与社会认知理论一致，我们样本中的依从性问题与自我效能感不足以及不支持100%依从目标的感知规范和行为意图有关。我们建议，以社会认知理论为指导的改善依从性的干预措施：（1）针对有依从性问题风险的患者；（2）提供促进高依从率的支持性环境；（3）解决关于最佳依从水平的不准确信念。
