Gross Israel Moses, Hosek Sybil, Richards Maryse Heather, Fernandez M Isabel
1 Department of Psychiatry, John H. Stroger Hospital of Cook County , Chicago, Illinois.
2 Department of Psychology, Loyola University Chicago , Illinois.
AIDS Patient Care STDS. 2016 Jul;30(7):324-38. doi: 10.1089/apc.2015.0351.
Adherence to antiretroviral therapy (ART) is crucial for thwarting HIV disease progression and reducing secondary HIV transmission, yet youth living with HIV (YLH) struggle with adherence. The highest rates of new HIV infections in the United States occur in young African American men. A sample of 387 HIV-positive young African American males on ART was selected from a cross-sectional assessment of (YLH) receiving medical care within the Adolescent Trials Network for HIV/AIDS Interventions (ATN) from 2010 to 2012 (12-24 years old, median 22.00, SD 2.08). Participants completed self-reported adherence, demographic, health, and psychosocial measures. Sixty-two percent self-reported 100% ART adherence. Optimal data analysis identified frequency of cannabis use during the past 3 months as the strongest independent predictor of adherence, yielding moderate effect strength sensitivity (ESS) = 27.1, p < 0.001. Among participants with infrequent cannabis use, 72% reported full adherence; in contrast, only 45% of participants who used cannabis frequently reported full adherence. Classification tree analysis (CTA) was utilized to improve classification accuracy and to identify the pathways of ART adherence and nonadherence. The CTA model evidenced a 38% improvement above chance for correctly classifying participants as ART adherent or nonadherent. Participants most likely to be adherent were those with low psychological distress and minimal alcohol use (82% were adherent). Participants least likely to be adherent were those with higher psychological distress and engaged in weekly cannabis use (69% were nonadherent). Findings suggest multiple profiles of ART adherence for young African American males living with HIV and argue for targeted psychosocial interventions.
坚持抗逆转录病毒疗法（ART）对于阻止HIV疾病进展和减少HIV二次传播至关重要，但感染HIV的青年（YLH）在坚持治疗方面面临困难。美国新增HIV感染率最高的人群是年轻的非裔美国男性。从2010年至2012年在青少年HIV/艾滋病干预试验网络（ATN）接受医疗护理的感染HIV青年（YLH）的横断面评估中选取了387名接受ART治疗的HIV阳性年轻非裔美国男性样本（年龄在12 - 24岁之间，中位数为22.00，标准差为2.08）。参与者完成了自我报告的治疗依从性、人口统计学、健康状况和心理社会指标的测量。62%的人自我报告ART依从率为100%。最佳数据分析确定过去3个月内大麻使用频率是依从性最强的独立预测因素，产生中等效应强度敏感性（ESS）= 27.1，p < 0.001。在很少使用大麻的参与者中，72%报告完全依从；相比之下，经常使用大麻的参与者中只有45%报告完全依从。采用分类树分析（CTA）来提高分类准确性，并确定ART依从和不依从的途径。CTA模型在正确将参与者分类为ART依从或不依从方面比随机分类有38%的提升。最有可能依从的参与者是心理困扰低且饮酒量少的人（82%依从）。最不可能依从的参与者是心理困扰较高且每周使用大麻的人（69%不依从）。研究结果表明感染HIV的年轻非裔美国男性有多种ART依从模式，并主张进行有针对性的心理社会干预。
