自我报告的依从性与 HAART 中的治疗药物监测相比如何？
How well does self-reported adherence fare compared to therapeutic drug monitoring in HAART?
机构信息
Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Malaysia.
出版信息
Prev Med. 2013;57 Suppl:S34-6. doi: 10.1016/j.ypmed.2013.01.002. Epub 2013 Jan 11.
OBJECTIVE
The aim of the study was to determine how well self-reported adherence fares compared to therapeutic drug monitoring in monitoring HAART adherence.
METHODS
We administered a validated self-reported adherence (SRA) questionnaire to 925 HIV patients on HAART in a large Malaysian hospital from 2010 to 11. We also performed Therapeutic Drug monitoring (TDM) by concurrently collecting and testing blood samples for Efavirenz, Nevirapine and Lamivudine using Liquid Chromatography/Mass Spectrometry. We compared the SRA against the TDM results. Sensitivity, specificity, positive (PPV) and negative predictive (NPV) and diagnostic accuracy values were computed for each drug.
RESULTS
Self-reported adherence (SRA) over-estimates adherence by between 6 and 10 percentage points compared to therapeutic drug monitoring (TDM). SRA is highly sensitive with sensitivity exceeding 0.90 but is not very specific (0.56-0.63). PPV for SRA ranged between 0.76 (Lamivudine) and 0.84 (Efavirenz) while NPV ranged between 0.78 (Lamivudine) and 0.81 (Efavirenz). Overall diagnostic accuracy ranged between 0.76 (Lamivudine) and 0.84 (Nevirapine).
CONCLUSION
Self-reported adherence is a surprisingly accurate instrument for measuring HAART adherence compared to TDM and can be reliably used in practice in resource-poor settings.
目的
本研究旨在比较自我报告的依从性与治疗药物监测（therapeutic drug monitoring，TDM）在监测高效抗逆转录病毒治疗（highly active antiretroviral therapy，HAART）依从性方面的表现。
方法
我们在 2010 年至 2011 年期间，对马来西亚一家大型医院的 925 名接受 HAART 的 HIV 患者进行了一项经过验证的自我报告依从性（self-reported adherence，SRA）问卷评估，并同时采集和检测了依非韦伦、奈韦拉平、拉米夫定的血药浓度，采用液相色谱/质谱法进行了 TDM。我们将 SRA 与 TDM 结果进行了比较。计算了每种药物的敏感性、特异性、阳性预测值（positive predictive value，PPV）、阴性预测值（negative predictive value，NPV）和诊断准确性值。
结果
与 TDM 相比，自我报告的依从性（SRA）高估了 6%至 10%的依从性。SRA 具有很高的敏感性，敏感性超过 0.90，但特异性不高（0.56-0.63）。SRA 的 PPV 范围为 0.76（拉米夫定）至 0.84（依非韦伦），NPV 范围为 0.78（拉米夫定）至 0.81（依非韦伦）。总体诊断准确性范围为 0.76（拉米夫定）至 0.84（奈韦拉平）。
结论
与 TDM 相比，自我报告的依从性是一种测量 HAART 依从性的令人惊讶的准确工具，在资源匮乏的环境中可以可靠地用于实践。
Zotero 插件