Sheppard-Law Suzanne, Zablotska-Manos Iryna, Kermeen Melissa, Holdaway Susan, Lee Alice, George Jacob, Zekry Amany, Maher Lisa
University of Technology Sydney, Faculty of Health, Broadway, NSW, Australia.
Sydney Children's Hospital Randwick, Nursing Research Unit, Randwick, NSW, Australia.
Antivir Ther. 2018;23(5):425-433. doi: 10.3851/IMP3219.
HBV antiviral therapy has the potential to reduce the burden of HBV-related liver disease by suppressing HBV DNA replication to undetectable levels, reducing the progression of liver fibrosis and reducing the risk of hepatocellular carcinoma (HCC) development. Treatment outcomes and long-term benefits require adherence to medication regimens. This study aimed to identify the prevalence and factors associated with non-adherence to antiviral therapy.
A cross-sectional survey of patients receiving HBV antiviral therapies was conducted in three Sydney hospitals. Participants were asked to complete an online questionnaire. Logistic regression was used to assess the associations between non-adherence (defined as missing more than 1 day of medication in the last 30 days) and demographic, socio-economic, disease, treatment, health-care system and individual-related factors.
Of the 277 participants, 66 (23.8%) were non-adherent, missing a mean 1.7 days of medication (sd 4.8) in the last 30 days. In multivariate analysis, non-adherent behaviour declined with age (odds ratio [OR] 0.9, 95% CI 0.97, 0.99; P<0.013). Participants who reported having no established routine to take their medication (OR 5.0, 95% CI 1.4, 17.4; P<0.012) and having inadequate health literacy (OR 2.7, 95% CI 1.3, 5.5; P<0.007) were more likely to be non-adherent.
Almost a quarter of participants in the current study were non-adherent. Adherence is potentially modifiable through person-centred education, collaborative models of patient care and interventions designed to improve health literacy and establish medication routines. Findings have the potential to improve health service delivery to patients at risk of non-adherence to HBV antiviral therapy.
乙肝抗病毒治疗有可能通过将乙肝病毒脱氧核糖核酸（HBV DNA）复制抑制到检测不到的水平、减缓肝纤维化进程以及降低肝细胞癌（HCC）发生风险，来减轻乙肝相关肝病的负担。治疗效果和长期益处需要坚持药物治疗方案。本研究旨在确定抗病毒治疗不依从的发生率及其相关因素。
在悉尼的三家医院对接受乙肝抗病毒治疗的患者进行了横断面调查。参与者被要求完成一份在线问卷。采用逻辑回归分析评估不依从（定义为在过去30天内漏服药物超过1天）与人口统计学、社会经济、疾病、治疗、医疗保健系统及个人相关因素之间的关联。
在277名参与者中，66名（23.8%）不依从，在过去30天内平均漏服1.7天药物（标准差4.8）。多变量分析显示，不依从行为随年龄增长而减少（比值比[OR]为0.9，95%置信区间为0.97至0.99；P<0.013）。报告没有固定服药习惯的参与者（OR为5.0，95%置信区间为1.4至17.4；P<0.012）以及健康素养不足的参与者（OR为2.7，95%置信区间为1.3至5.5；P<0.007）更有可能不依从。
本研究中近四分之一的参与者不依从。通过以患者为中心的教育、协作式患者护理模式以及旨在提高健康素养和建立服药习惯的干预措施，依从性有可能得到改善。研究结果有可能改善对有乙肝抗病毒治疗不依从风险患者的医疗服务。
