Chen Wei-Ti, Shiu Chengshi, Yang Joyce P, Chuang Peing, Zhang Lin, Bao Meijuan, Lu Hongzhou
a School of Nursing , Yale University , Orange , CT , USA.
b School of Social Work , University of Washington , Seattle , WA , USA.
AIDS Care. 2018 Mar;30(3):383-390. doi: 10.1080/09540121.2017.1380778. Epub 2017 Sep 21.
Obtaining maximum antiretroviral therapy (ART) adherence is critical for maintaining a high CD4 count and strong immune function in PLWHA. Key factors for achieving optimum adherence include good medication self-efficacy, decreased medication-taking difficulties, and positive patient-healthcare provider (HCP) relationships. Limited studies have analyzed the correlation of these factors and ART adherence in Chinese population. In this paper, structural equation modeling was performed to assess the proposed model of relations between patient-HCP relationships and adherence. Audio Computer-Assisted Self-Interview (ACASI) software was used to collect data on ART adherence and patient variables among 227 PLWHA in Shanghai and Taipei. Participants completed a one-time 60-minute ACASI survey that consisted of standardized measures to assess demographics, recent CD4 counts, self-efficacy, patient-HCP relationship, adherence, and medication-taking difficulties. The data shown the relationship between patient-HCP relationships and adherence was significantly consistent with mediation by medication self-efficacy. However, patient-HCP interaction did not directly influence medication-taking difficulties, and medication-taking difficulties did not significantly affect CD4 counts. Furthermore, patient-HCP interactions did not directly impact CD4 counts; rather, the relation was consistent with mediation (by either better medication self-efficacy or better adherence) or by improved adherence alone. Future interventions should be designed to enhance self-management and provide better patient-HCP communication. This improved communication will enhance medication self-efficacy and decrease medication-taking difficulties. This in turn will improve medication adherence and immune function among PLWHA.
实现最大程度的抗逆转录病毒疗法（ART）依从性对于维持艾滋病病毒感染者（PLWHA）的高CD4细胞计数和强大免疫功能至关重要。实现最佳依从性的关键因素包括良好的药物自我效能感、减少服药困难以及患者与医护人员（HCP）之间的积极关系。针对中国人群中这些因素与ART依从性之间的相关性进行分析的研究有限。本文进行了结构方程建模，以评估所提出的患者与医护人员关系和依从性之间的关系模型。使用音频计算机辅助自我访谈（ACASI）软件收集了上海和台北227名艾滋病病毒感染者的ART依从性和患者变量数据。参与者完成了一次60分钟的ACASI调查，该调查包括评估人口统计学、近期CD4细胞计数、自我效能感、患者与医护人员关系、依从性和服药困难的标准化测量。数据显示，患者与医护人员关系和依从性之间的关系与药物自我效能感的中介作用显著一致。然而，患者与医护人员的互动并未直接影响服药困难，服药困难也未对CD4细胞计数产生显著影响。此外，患者与医护人员的互动并未直接影响CD4细胞计数；相反，这种关系与中介作用（通过更好的药物自我效能感或更好的依从性）或仅通过改善依从性一致。未来的干预措施应旨在加强自我管理并提供更好的患者与医护人员沟通。这种改善的沟通将增强药物自我效能感并减少服药困难。这反过来将改善艾滋病病毒感染者的药物依从性和免疫功能。
