Bam Kiran, Rajbhandari Rajesh M, Karmacharya Dibesh B, Dixit Sameer M
Center for Molecular Dynamics Nepal (CMDN), Thapathali, Kathmandu, Nepal.
BMC Health Serv Res. 2015 May 5;15:188. doi: 10.1186/s12913-015-0846-8.
Anti Retroviral Therapy (ART) is the cornerstone for comprehensive health sector response to Human Immunodeficiency Virus (HIV) treatment, care and support. Adherence of at least 95% is needed to keep HIV under control, as per World Health Organization (WHO) guidelines. This study was aimed at identifying the overall adherence level of, and barriers and facilitators to adherence for patients taking ART in different clinics in all five development regions of Nepal.
A descriptive cross-sectional study was conducted among ART clients receiving free ART from Government of Nepal ART clinics. A total of 435 clients taking ART from twelve ART clinics in different regions of Nepal, aged fifteen years and above were interviewed on one-and-one basis using questionnaires developed in reference to Adult AIDS Clinical Trial Group (AACTG) toolkit among them data from 404 were analyzed after cleaning. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) software where the P value of < 0.05 was accepted as being statistically significant.
The overall adherence in the last month (missed less than three pills total) was 94.8% (383 out of 404). The main barrier to ART adherence was the fear of side effects (among 61.9% of the non adherent population) which included dizziness (18.1%) and headaches (15.4%). The standard wristwatch (39%) was found to be the most useful aid in enabling timely consumption of medication. Educational status (P = 0.018), drug using habits (P = 0.039) and the conducive environment at ART clinics (P = 0.004) were significantly associated with ART adherence.
Improving better adherence may require a more holistic approach to treatment regimen and adapting it to patient daily routines. This study identifies issues such as pill count for assessing adherence, better access to health care facilities by clients, better access to medication, as well as improved nutritional support issues for better adherence by the population in the future.
抗逆转录病毒疗法（ART）是卫生部门全面应对人类免疫缺陷病毒（HIV）治疗、护理及支持工作的基石。根据世界卫生组织（WHO）的指导方针，需要至少95%的依从性才能控制HIV。本研究旨在确定尼泊尔所有五个发展区域不同诊所接受抗逆转录病毒治疗患者的总体依从水平、依从性的障碍及促进因素。
对从尼泊尔政府抗逆转录病毒治疗诊所接受免费抗逆转录病毒治疗的患者开展了一项描述性横断面研究。对尼泊尔不同地区12家抗逆转录病毒治疗诊所中435名年龄在15岁及以上接受抗逆转录病毒治疗的患者进行一对一访谈，使用参考成人艾滋病临床试验组（AACTG）工具包编制的问卷进行调查，其中404份数据在清理后进行分析。使用社会科学统计软件包（SPSS）软件录入和分析数据，P值<0.05被认为具有统计学意义。
上个月的总体依从性（总共漏服少于三片药）为94.8%（404人中的383人）。抗逆转录病毒治疗依从性的主要障碍是对副作用的恐惧（在61.9%的非依从人群中），其中包括头晕（18.1%）和头痛（15.4%）。标准手表（39%）被认为是帮助按时服药最有用的辅助工具。教育程度（P = 0.018）、吸毒习惯（P = 0.039）和抗逆转录病毒治疗诊所的有利环境（P = 0.004）与抗逆转录病毒治疗依从性显著相关。
提高依从性可能需要对治疗方案采取更全面的方法，并使其适应患者的日常生活。本研究确定了评估依从性的药片计数、患者更好地获得医疗保健设施、更好地获得药物以及改善营养支持等问题，以便未来人群能更好地依从治疗。
