医疗保健赋权和 HIV 病毒控制：在护理中坚持治疗和保持治疗的中介作用。
Healthcare Empowerment and HIV Viral Control: Mediating Roles of Adherence and Retention in Care.
机构信息
Department of Community Health Sciences, State University of New York, Downstate Medical Center School of Public Health, Brooklyn, New York.
School of Social Work, University of Alabama, Tuscaloosa, Alabama.
出版信息
Am J Prev Med. 2018 Jun;54(6):756-764. doi: 10.1016/j.amepre.2018.02.012. Epub 2018 Apr 12.
INTRODUCTION
This study assessed longitudinal relationships between patient healthcare empowerment, engagement in care, and viral control in the Women's Interagency HIV Study, a prospective cohort study of U.S. women living with HIV.
METHODS
From April 2014 to March 2016, four consecutive 6-month visits were analyzed among 973 women to assess the impact of Time 1 healthcare empowerment variables (Tolerance for Uncertainty and the state of Informed Collaboration Committed Engagement) on Time 2 reports of ≥95% HIV medication adherence and not missing an HIV primary care appointment since last visit; and on HIV RNA viral control across Times 3 and 4, controlling for illicit drug use, heavy drinking, depression symptoms, age, and income. Data were analyzed in 2017.
RESULTS
Adherence of ≥95% was reported by 83% of women, 90% reported not missing an appointment since the last study visit, and 80% were categorized as having viral control. Logistic regression analyses revealed a significant association between the Informed Collaboration Committed Engagement subscale and viral control, controlling for model covariates (AOR=1.08, p=0.04), but not for the Tolerance for Uncertainty subscale and viral control (AOR=0.99, p=0.68). In separate mediation analyses, the indirect effect of Informed Collaboration Committed Engagement on viral control through adherence (β=0.04, SE=0.02, 95% CI=0.02, 0.08), and the indirect effect of Informed Collaboration Committed Engagement on viral control through retention (β=0.01, SE=0.008, 95% CI=0.001, 0.030) were significant. Mediation analyses with Tolerance for Uncertainty as the predictor did not yield significant indirect effects.
CONCLUSIONS
The Informed Collaboration Committed Engagement healthcare empowerment component is a promising pathway through which to promote engagement in care among women living with HIV.
简介
本研究评估了患者医疗保健授权、参与护理和病毒控制之间的纵向关系，该研究是在美国妇女艾滋病毒研究中进行的一项前瞻性队列研究。
方法
从 2014 年 4 月至 2016 年 3 月，对 973 名女性进行了连续四次 6 个月的访视，以评估时间 1 医疗保健授权变量（不确定性容忍度和知情协作承诺状态）对时间 2 报告的影响，报告的时间 2 为≥95%的 HIV 药物依从性和自上次就诊以来未错过 HIV 初级保健预约；以及在时间 3 和 4 时的 HIV RNA 病毒控制，控制非法药物使用、大量饮酒、抑郁症状、年龄和收入。数据于 2017 年进行分析。
结果
83%的女性报告了≥95%的依从性，90%的女性报告自上次研究就诊以来未错过预约，80%的女性被归类为具有病毒控制。逻辑回归分析显示，在控制模型协变量后，知情协作承诺子量表与病毒控制显著相关（AOR=1.08，p=0.04），但不确定性容忍度子量表与病毒控制不相关（AOR=0.99，p=0.68）。在单独的中介分析中，通过依从性（β=0.04，SE=0.02，95%CI=0.02，0.08）和通过保留（β=0.01，SE=0.008，95%CI=0.001，0.030），知情协作承诺对病毒控制的间接效应在统计学上显著。以不确定性容忍度为预测因子的中介分析没有产生显著的间接效应。
结论
知情协作承诺的医疗保健授权组成部分是促进 HIV 感染者参与护理的一个有前途的途径。
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