Deparment of Statistics, Bahir Dar University, Bahir Dar, Ethiopia.
Department of Statistics, Unisa, Pretoria, South Africa.
BMC Infect Dis. 2018 Feb 20;18(1):83. doi: 10.1186/s12879-018-2977-0.
Non-adherence to Highly Active Antiretroviral Therapy (HAART) is one of the factors for treatment failure in human immunodeficiency virus (HIV) infected patients in developing countries. The main objective of this study was to identify factors for treatment failure among adult HIV patients based on the assessment of first month adherence in the study area.
The study was conducted using secondary data from antiretroviral unit at Felege Hiwot Teaching and Specialized Hospital. A prospective study was undertaken on 792 randomly selected adult HIV positive patients who have started HAART. The variable of interest, adherence to HAART was categorized as non-adherence if a patient had taken less than 95% of the prescribed medication and this was measured using pill counts. Descriptive statistics, Chi-square tests of association, independent samples t-test and binary logistic regression were used for data analysis.
In first month therapy, 68.2% of the patients belong to adherence group to HAART. As age increases, a patient without cell phone was less likely to be adherent to HAART as compared to patients with cell phone (AOR = 0.661, 95% CI: (0.243, 0.964)). Compared to urban patients, rural patients were less likely to adhere to HAART (AOR = 0.995, 95% CI: (0.403, 0.999)). A patient who did not disclose his/her disease to families or communities had less probability to be adherent to HAART (AOR = 0.325, 95% CI: (0.01, 0.64)). Similarly, a patient who did not get social support (AOR = 0.42, 95% CI: (0,021, 0.473)) had less probability of adherence to HAART. The main reasons for patients to be non-adherent were forgetfulness, side effects, feeling sick and running out of medication.
This study indentified certain groups of patients who are at higher risk and who need counseling. Such groups should be targeted and tailored for improvement of adherence to HAART among HIV positive adults. The health care providers should advise the community to provide social support to HIV positive patients whenever their disease is disclosed. On the other hand, patients should disclose their disease to community to get integrated supports. HIV infected patients who are directed to start HAART should adhere the prescribed medication. For the adherence to be effective, patients who have cell phone should use them as reminder to take pills on time.
在发展中国家，不遵守高效抗逆转录病毒疗法（HAART）是导致人类免疫缺陷病毒（HIV）感染患者治疗失败的因素之一。本研究的主要目的是根据研究区域内对第一个月依从性的评估，确定成人 HIV 患者治疗失败的因素。
本研究使用 Felege Hiwot 教学和专科医院抗逆转录病毒科的二次数据进行。对 792 名随机选择的开始接受 HAART 的成年 HIV 阳性患者进行了前瞻性研究。如果患者服用的药物少于规定剂量的 95%，则将 HAART 的依从性归类为不依从，这是通过药丸计数来衡量的。采用描述性统计、卡方检验、独立样本 t 检验和二元逻辑回归进行数据分析。
在第一个月的治疗中，68.2%的患者属于 HAART 依从组。随着年龄的增长，没有手机的患者不太可能像有手机的患者那样遵守 HAART（AOR=0.661，95%CI：（0.243，0.964））。与城市患者相比，农村患者不太可能遵守 HAART（AOR=0.995，95%CI：（0.403，0.999））。未向家人或社区透露病情的患者不太可能遵守 HAART（AOR=0.325，95%CI：（0.01，0.64））。同样，未获得社会支持的患者（AOR=0.42，95%CI：（0，021，0.473））遵守 HAART 的可能性也较低。患者不遵守的主要原因是健忘、副作用、生病和药物用尽。
本研究确定了某些高危人群，需要进行咨询。应针对这些人群进行靶向治疗，以提高 HIV 阳性成年人对 HAART 的依从性。卫生保健提供者应建议社区在 HIV 阳性患者透露病情时为其提供社会支持。另一方面，患者应向社区透露自己的病情，以获得综合支持。指导开始接受 HAART 的 HIV 感染者应遵守规定的药物。为了使依从性有效，有手机的患者应使用手机作为按时服药的提醒。
