Monroe A K, Pena J S, Moore R D, Riekert K A, Eakin M N, Kripalani S, Chander G
a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
b Division of Pulmonary and Critical Care Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
AIDS Care. 2018 Feb;30(2):199-206. doi: 10.1080/09540121.2017.1360993. Epub 2017 Aug 10.
As the HIV-infected population ages and the burden of chronic comorbidities increases, adherence to medications for HIV and diabetes and hypertension is crucial to improve outcomes. We pilot-tested a pictorial aid intervention to improve medication adherence for both HIV and common chronic conditions. Adult patients with HIV and diabetes (DM) and/or hypertension (HTN) attending a clinic for underserved patients and at risk for poor health outcomes were enrolled. Patients were randomized to receive either a pictorial aid intervention (a photographic representation of their medications, the indications, and the dosing schedule) or a standard clinic visit discharge medication list. Adherence to antiretroviral therapy (ART) for HIV and therapy for DM or HTN was compared. Predictors of ART adherence at baseline were determined using logistic regression. Medication adherence was assessed using medication possession ratio (MPR) for the 6-month interval before and after the intervention. Change in adherence by treatment group was compared by ANOVA. Among the 46 participants, there was a trend towards higher adherence to medications for HIV compared with medications for hypertension/diabetes (baseline median MPR for ART 0.92; baseline median MPR for the medication for the comorbid condition 0.79, p = 0.07). The intervention was feasible to implement and satisfaction with the intervention was high. With a small sample size, the intervention did not demonstrate significant improvement in adherence to medications for HIV or comorbid conditions. Patients with HIV are often medically complex and may have multiple barriers to medication adherence. Medication adherence is a multifaceted process and adherence promotion interventions require an approach that targets patient-specific barriers.
随着感染艾滋病毒的人群老龄化以及慢性合并症负担增加，坚持服用治疗艾滋病毒、糖尿病和高血压的药物对于改善治疗效果至关重要。我们对一种图片辅助干预措施进行了试点测试，以提高艾滋病毒及常见慢性病的药物依从性。纳入了在一家为服务不足患者开设的诊所就诊且健康状况不佳风险较高的成年艾滋病毒感染者兼糖尿病患者和/或高血压患者。患者被随机分为接受图片辅助干预措施组（其药物、适应症和给药时间表的照片展示）或标准门诊出院药物清单组。比较了艾滋病毒抗逆转录病毒疗法（ART）以及糖尿病或高血压治疗的依从性。使用逻辑回归确定基线时ART依从性的预测因素。使用干预前后6个月期间的药物持有率（MPR）评估药物依从性。通过方差分析比较治疗组之间依从性的变化。在46名参与者中，与高血压/糖尿病药物相比，艾滋病毒药物的依从性有升高趋势（ART的基线中位MPR为0.92；合并症药物的基线中位MPR为0.79，p = 0.07）。该干预措施实施可行，对干预措施的满意度较高。由于样本量较小，该干预措施未显示出艾滋病毒或合并症药物依从性有显著改善。艾滋病毒感染者通常病情复杂，在药物依从性方面可能存在多种障碍。药物依从性是一个多方面的过程，促进依从性的干预措施需要针对患者特定障碍的方法。
