Kalichman Seth, Kalichman Moira O, Cherry Chauncey
a Department of Psychology , University of Connecticut , Storrs , CT , USA.
Psychol Health. 2016;31(4):383-95. doi: 10.1080/08870446.2015.1111371. Epub 2015 Nov 24.
People living in poverty face multiple structural challenges to medication adherence including lack of transportation, inadequate housing and food insecurity. The degree to which individuals' motivations to remain adherent may overcome structural barriers has received limited attention.
To examine whether medication necessity and concerns beliefs predict antiretroviral therapy (ART) adherence over and above structural adherence barriers associated with poverty.
People living with HIV in a southern US city (N = 942) completed computerised interviews, an objective measure of adherence and HIV viral suppression obtained from medical records. Hierarchical logistic regression models were constructed to examine demographic and illness characteristics, structural barriers, mental health, substance use and medication necessity and concerns beliefs as predictors of ART adherence.
In multivariable models, current drug use and medication necessity and concerns beliefs predicted treatment adherence over and above demographic, health, mental health and structural factors.
Medication beliefs are proximal and powerful motivating factors that predict adherence. Adherence interventions should directly address medication beliefs in developing strategies to manage barriers facing people with HIV living in poverty.
生活贫困的人群在药物依从性上面临多重结构性挑战，包括交通不便、住房条件差和粮食不安全。个体坚持服药的动机在多大程度上能够克服这些结构性障碍，这方面受到的关注有限。
探讨药物必要性和担忧信念在与贫困相关的结构性依从障碍之外，是否能预测抗逆转录病毒疗法（ART）的依从性。
美国南部一个城市的942名艾滋病毒感染者完成了计算机化访谈，并从医疗记录中获取了依从性和艾滋病毒病毒抑制的客观测量数据。构建分层逻辑回归模型，以检验人口统计学和疾病特征、结构性障碍、心理健康、物质使用以及药物必要性和担忧信念作为ART依从性的预测因素。
在多变量模型中，当前药物使用、药物必要性和担忧信念在人口统计学、健康、心理健康和结构性因素之外，还能预测治疗依从性。
药物信念是预测依从性的直接且有力的激励因素。在制定应对贫困艾滋病毒感染者所面临障碍的策略时，依从性干预措施应直接针对药物信念。
