McKinney Ogbochi, Modeste Naomi N, Lee Jerry W, Gleason Peter C
School of Public Health, Loma Linda University , CA, USA.
J Public Health Res. 2015 Jul 16;4(2):533. doi: 10.4081/jphr.2015.533.
With the increase in scaling up of antiretroviral therapy (ART), knowledge of the need for adherence to ART is pivotal for successful treatment outcomes.
A cross-sectional study was carried out between October and December 2013. We administered theory of planned behaviour (TPB) and adherence questionnaires to 358 women aged 18-49 years, from a rural and urban ART-clinics in southern Malawi. Hierarchical linear regression models were used to predict intentions to adhere to ART.
Regression models show that attitude (β=0.47), subjective norm (β=0.31) and perceived behavioural control (β=0.12) explain 55% of the variance in intentions to adhere to ART. The relationship between both food insecurity and perceived side effects with intentions to adhere to ART is mediated by attitude, subjective norm, and perceived behavioural control. Household (r=0.20) and individual (r=0.21) food insecurity were positively and significantly correlated with perceived behavioural control. Household food insecurity had a negative correlation with perceived side effects (r=-0.11). Perceived side effects were positively correlated with attitude (r=0.25). There was no statistically significant relationship between intentions to adhere to ART in the future and one month self-report of past month adherence. These interactions suggest that attitude predicted adherence only when food insecurity is high or perception of side effects is strong.
This study shows that modification might be needed when using TPB constructs in resource constraint environments. Significance for public healthThe knowledge of the rates of adherence to antiretroviral therapy (ART) could be used to evaluate planning and project, which could lead to better outcomes predicted by treatment efficacy data. In addition, knowledge of adherence behaviour could help the development of interventions focusing on collaboration between healthcare providers and Malawian government to provide food support for patients on ART. The interventions could also focus on providing better counselling support to improve beliefs regarding control over taking the medication and perceived versus real side effects. It is relevant for public health professors to understand factors influencing women's ART adherence, in order to create interventions that are appropriate for increasing ART adherence, which may lead to improved outcomes among women with HIV living in endemic regions with limited treatment access.
随着抗逆转录病毒疗法（ART）推广规模的扩大，了解坚持ART治疗的必要性对于取得成功的治疗效果至关重要。
于2013年10月至12月开展了一项横断面研究。我们对来自马拉维南部农村和城市ART诊所的358名年龄在18 - 49岁的女性进行了计划行为理论（TPB）和依从性问卷调查。采用分层线性回归模型预测坚持ART治疗的意愿。
回归模型显示，态度（β = 0.47）、主观规范（β = 0.31）和感知行为控制（β = 0.12）解释了坚持ART治疗意愿中55%的变异。粮食不安全和感知到的副作用与坚持ART治疗意愿之间的关系是由态度、主观规范和感知行为控制介导的。家庭粮食不安全（r = 0.20）和个人粮食不安全（r = 0.21）与感知行为控制呈显著正相关。家庭粮食不安全与感知到的副作用呈负相关（r = -0.11）。感知到的副作用与态度呈正相关（r = 0.25）。未来坚持ART治疗的意愿与过去一个月自我报告的坚持情况之间没有统计学上的显著关系。这些相互作用表明，只有当粮食不安全程度高或对副作用感知强烈时，态度才能预测依从性。
本研究表明，在资源受限环境中使用TPB结构时可能需要进行调整。对公共卫生的意义抗逆转录病毒疗法（ART）的依从率知识可用于评估规划和项目，这可能会带来治疗效果数据所预测的更好结果。此外，依从行为的知识有助于制定干预措施，重点是医疗服务提供者与马拉维政府之间的合作，为接受ART治疗的患者提供食物支持。干预措施还可侧重于提供更好的咨询支持，以改善对服药控制以及感知到的与实际副作用的信念。公共卫生教授了解影响女性ART依从性的因素很有必要，以便制定适合提高ART依从性的干预措施，这可能会改善生活在治疗机会有限的流行地区的感染HIV女性的治疗效果。
