Wroe Emily B, Hedt-Gauthier Bethany L, Franke Molly F, Nsanzimana Sabin, Turinimana Jean Bosco, Drobac Peter
Department of Internal Medicine, Brigham & Women's Hospital, Boston, MA, USA Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA University of Rwanda College of Medicine and Health Sciences, Butare, Rwanda.
Int J STD AIDS. 2015 Mar;26(4):257-61. doi: 10.1177/0956462414535206. Epub 2014 May 14.
We determined the prevalence of depression in HIV-infected adults on antiretroviral therapy in rural Rwanda and measured the association of depression with non-adherence. In all, 292 patients on antiretroviral therapy for ≥6 months were included. Adherence was self-reported by four-day recall, two- and seven-day treatment interruptions, and the CASE Index, which is a composite score accounting for difficulty taking medications on time, the average number of days per week a dose is missed, and the most recent missed dose. A total of 84% and 87% of participants reported good adherence by the four-day recall and CASE Index, respectively; 13% of participants reported two-day treatment interruptions; and 11% were depressed. Depression was significantly associated with two-day treatment interruptions but not with other measures of non-adherence. Self-reported adherence to antiretroviral therapy in rural Rwanda is high. Adherence assessments that do not consider treatment interruptions may miss important patterns of non-adherence, which may be especially prevalent among depressed individuals. Mental health interventions incorporated into routine HIV care may lead to improvements in mental health and adherence.
我们确定了卢旺达农村地区接受抗逆转录病毒治疗的HIV感染成人中抑郁症的患病率，并测量了抑郁症与治疗不依从之间的关联。总共纳入了292名接受抗逆转录病毒治疗≥6个月的患者。依从性通过4天回忆法、2天和7天治疗中断情况以及CASE指数进行自我报告，CASE指数是一个综合评分，考虑按时服药的困难程度、每周错过剂量的平均天数以及最近一次错过的剂量。分别有84%和87%的参与者通过4天回忆法和CASE指数报告依从性良好；13%的参与者报告有2天治疗中断；11%的参与者患有抑郁症。抑郁症与2天治疗中断显著相关，但与其他治疗不依从的指标无关。卢旺达农村地区抗逆转录病毒治疗的自我报告依从性较高。不考虑治疗中断情况的依从性评估可能会遗漏重要的不依从模式，而这些模式在抑郁症患者中可能尤为普遍。将心理健康干预纳入常规HIV护理可能会改善心理健康和依从性。
