巴西里约热内卢公立诊所就诊人群抗逆转录病毒药物依从性的个体和环境影响因素。
Individual and contextual factors of influence on adherence to antiretrovirals among people attending public clinics in Rio de Janeiro, Brazil.
机构信息
Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
出版信息
BMC Public Health. 2013 Jun 13;13:574. doi: 10.1186/1471-2458-13-574.
BACKGROUND
There are inconsistencies in the determinants of adherence to antiretrovirals (ARVs) across settings as well as a lack of studies that take into consideration factors beyond the individual level. This makes it necessary to examine factors holistically in multiple settings and populations while taking into consideration the particularities of each context, in order to understand the patterns of ARV adherence. This research explored ARV adherence and individual, relational and environmental-structural factors.
METHODS
A cross-sectional survey was conducted from August 2008 through July 2009 among participants currently on ARVs recruited from 6 public health clinics, selected to maximize diversity in terms of caseload and location, representing the range of clinics within Rio de Janeiro city, Brazil. Multivariate logistic regression analysis was used to assess the association between our multilevel factors with ARV adherence among participants with complete cases (n = 632).
RESULTS
Eighty-four percent of respondents reported adherence to all of their ARV doses in the last 4 days. Of the socio-demographic variables, those who had one child were positively associated with adherence (AOR 2.29 CI [1.33-3.94]). On the relational level, those with high social support (AOR 2.85 CI [1.50-5.41]) were positively associated with adherence to ARVs. On the environmental-structural level, we found gender was significant with women negatively associated with adherence to ARVs (AOR 0.58 CI [0.38-0.88]) while those with a high asset index (AOR 2.47 CI [1.79-3.40]) were positively associated with adherence to ARVs.
CONCLUSIONS
This research highlights the importance of examining the multiple levels of influence on ARV adherence. Intervention research in lower and middle-income settings should address and evaluate the impact of attending to both gender and economic inequalities to improve ARV adherence, as well as relational areas such as the provision of social support.
背景
在不同环境下，抗逆转录病毒药物（ARV）的依从性决定因素存在不一致，而且缺乏考虑个体水平以外因素的研究。这使得有必要在多个环境和人群中全面检查这些因素，同时考虑到每个环境的特殊性，以便了解 ARV 依从性的模式。本研究探讨了 ARV 依从性以及个体、关系和环境结构因素。
方法
2008 年 8 月至 2009 年 7 月期间，从巴西里约热内卢市的 6 家公共卫生诊所招募了正在接受 ARV 治疗的参与者，进行了一项横断面调查，以最大限度地扩大病例量和地点的多样性，代表了该城市范围内的各种诊所。使用多变量逻辑回归分析评估了参与者的多层次因素与完全病例（n = 632）中 ARV 依从性之间的关联。
结果
84%的受访者报告在过去 4 天内服用了所有的 ARV 剂量。在社会人口统计学变量中，有一个孩子的人与依从性呈正相关（优势比 2.29 CI [1.33-3.94]）。在关系层面，社会支持度高的人与 ARV 依从性呈正相关（优势比 2.85 CI [1.50-5.41]）。在环境结构层面，我们发现性别是显著的，女性与 ARV 依从性呈负相关（优势比 0.58 CI [0.38-0.88]），而资产指数高的人与 ARV 依从性呈正相关（优势比 2.47 CI [1.79-3.40]）。
结论
这项研究强调了检查 ARV 依从性的多个影响层次的重要性。中低收入环境下的干预研究应该解决和评估关注性别和经济不平等的影响，以提高 ARV 依从性，以及提供社会支持等关系领域。
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