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酒精对印度城市地区艾滋病毒感染者抗逆转录病毒治疗依从性的影响

The Role of Alcohol on Antiretroviral Therapy Adherence Among Persons Living With HIV in Urban India.

作者信息

Schensul Stephen L, Ha Toan, Schensul Jean J, Vaz Melita, Singh Rajendra, Burleson Joseph A, Bryant Kendall

机构信息

Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, Connecticut.

Institute for Community Research, Hartford, Connecticut.

出版信息

J Stud Alcohol Drugs. 2017 Sep;78(5):716-724. doi: 10.15288/jsad.2017.78.716.

DOI:10.15288/jsad.2017.78.716
PMID:28930059
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5675422/
Abstract

OBJECTIVE

The purpose of this study was to estimate the prevalence of alcohol use among men living with HIV on antiretroviral therapy (ART) and examine the association of alcohol use and psychosocial variables on ART adherence. The study was a cross-sectional survey supplemented by medical records and qualitative narratives as a part of the initial formative stage of a multilevel, multicentric intervention and evaluation project.

METHOD

A screening instrument was administered to men living with HIV (n = 3,088) at four ART Centers using the Alcohol Use Disorders Identification Test-consumption questions (AUDIT-C) to determine alcohol use for study eligibility. Alcohol screening data were triangulated with medical records of men living with HIV (n = 15,747) from 13 ART Centers to estimate alcohol consumption among men on ART in greater Mumbai. A survey instrument to identify associations between ART adherence and alcohol, psychosocial, and contextual factors was administered to eligible men living with HIV (n = 361), and in-depth interviews (n = 55) were conducted to elucidate the ways in which these factors are manifest in men's lives.

RESULTS

Nearly one fifth of men living with HIV on ART in the Mumbai area have consumed alcohol in the last 30 days. Non-adherence was associated with a higher AUDIT score, consumption of more types of alcohol, and poorer self-ratings on quality of life, depression, and external stigma. The qualitative data demonstrate that non-adherence results from avoiding the mixing of alcohol with medication, forgetfulness when drinking, and skipping medication for fear of disclosure of HIV status when drinking with friends.

CONCLUSIONS

As the demand for ART expands, Indian government programs will need to more effectively address alcohol to reduce risk and maintain effective adherence.

摘要

目的

本研究旨在评估接受抗逆转录病毒治疗(ART)的HIV感染者中酒精使用的流行情况,并探讨酒精使用与心理社会变量对ART依从性的关联。该研究是一项横断面调查,并辅以病历和定性叙述,作为一个多层次、多中心干预与评估项目初始形成阶段的一部分。

方法

在四个ART中心,使用酒精使用障碍识别测试-消费问题(AUDIT-C)对HIV感染者(n = 3088)进行筛查,以确定酒精使用情况,从而确定其是否符合研究条件。将酒精筛查数据与来自13个ART中心的HIV感染者(n = 15747)的病历进行三角验证,以估计孟买大都市区接受ART治疗的男性的酒精消费量。对符合条件的HIV感染者(n = 361)进行一项调查工具,以确定ART依从性与酒精、心理社会和背景因素之间的关联,并进行了深入访谈(n = 55),以阐明这些因素在男性生活中的表现方式。

结果

孟买地区接受ART治疗的HIV感染者中,近五分之一的人在过去30天内饮酒。不依从与较高的AUDIT评分、饮用更多种类的酒精以及在生活质量、抑郁和外部耻辱感方面较差的自我评分相关。定性数据表明,不依从是由于避免酒精与药物混合、饮酒时健忘以及因担心与朋友饮酒时暴露HIV感染状况而漏服药物所致。

结论

随着对ART需求的扩大,印度政府项目将需要更有效地解决酒精问题,以降低风险并维持有效的依从性。

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