调查社区家庭护理对尼泊尔 HIV 感染者心理健康和抗逆转录病毒治疗依从性的影响：一项社区干预研究。
Investigating the impact of a community home-based care on mental health and anti-retroviral therapy adherence in people living with HIV in Nepal: a community intervention study.
机构信息
Health Research and Social Development Forum Nepal, P.O. Box 24133, Thapathali, Kathmandu, Nepal.
Department of Psychiatry and Mental Health, Institute of Medicine, Tribhuwan University, Kathmandu, Nepal.
出版信息
BMC Infect Dis. 2018 Jun 7;18(1):263. doi: 10.1186/s12879-018-3170-1.
BACKGROUND
HIV-positive people often experience mental health disorders and engage in substance use when the disease progresses. In resource limited settings, mental health services are not integrated into HIV services. In Nepal, HIV-positive people do receive psychosocial support and other basic health care services from a community home-based care intervention; however, the effects of the intervention on health outcomes is not yet known. Therefore, we examined the impact of the intervention on mental health and antiretroviral therapy (ART) adherence.
METHODS
We conducted an intervention study to identify the effects of a community home-based care intervention on mental health disorders, substance use, and non-adherence to ART among HIV-positive people in Nepal from March to August 2015. In total, 344 participated in the intervention and another 338 were in the control group. The intervention was comprised of home-based psychosocial support and peer counseling, adherence support, basic health care, and referral services. We measured the participants' depression, anxiety, stress, substance use, and non-adherence to ART. We applied a generalized estimating equation to examine the effects of intervention on health outcomes.
RESULTS
The intervention had positive effects in reducing depressive symptoms [Adjusted Odds Ratio (AOR) = 0.44, p < 0.001)], anxiety (AOR = 0.54, p = 0.014), stress (β = - 3.98, p < 0.001), substance use (AOR = 0.51, p = 0.005), and non-adherence to ART (AOR = 0.62, p = 0.025) among its participants at six-month follow-up.
CONCLUSIONS
The intervention was effective in reducing mental health disorders, substance use, and non-adherence to ART among HIV-positive people. Community home-based care intervention can be applied in resource limited setting to improve the mental health of the HIV-positive people. Such intervention should be targeted to include more HIV-positive people in order to improve their ART adherence.
TRIAL REGISTRATION
ClinicalTrials.gov ID: NCT03505866 , Released Date: April 20, 2018.
背景
随着疾病的发展，HIV 阳性人群经常会出现心理健康障碍并滥用药物。在资源有限的环境下，心理健康服务并未与 HIV 服务相结合。在尼泊尔，HIV 阳性人群确实会从社区家庭护理干预中获得心理社会支持和其他基本的医疗保健服务；然而，干预对健康结果的影响尚不清楚。因此，我们研究了该干预对心理健康和抗逆转录病毒治疗（ART）依从性的影响。
方法
我们进行了一项干预研究，以确定尼泊尔社区家庭护理干预对 HIV 阳性人群的心理健康障碍、物质使用和 ART 不依从的影响。该研究于 2015 年 3 月至 8 月进行，共有 344 人参加了干预组，另有 338 人参加了对照组。干预组包括家庭为基础的心理社会支持和同伴咨询、依从性支持、基本保健和转介服务。我们测量了参与者的抑郁、焦虑、压力、物质使用和 ART 不依从情况。我们应用广义估计方程来检验干预对健康结果的影响。
结果
干预对降低抑郁症状（调整后比值比[OR] = 0.44，p < 0.001）、焦虑（调整后 OR = 0.54，p = 0.014）、压力（β = - 3.98，p < 0.001）、物质使用（调整后 OR = 0.51，p = 0.005）和 ART 不依从（调整后 OR = 0.62，p = 0.025）有积极影响，且在六个月的随访中，这些影响在干预组中得到了体现。
结论
该干预对降低 HIV 阳性人群的心理健康障碍、物质使用和 ART 不依从有效。社区家庭护理干预可以在资源有限的环境中应用，以改善 HIV 阳性人群的心理健康。此类干预措施应针对更多的 HIV 阳性人群，以提高他们的 ART 依从性。
试验注册
ClinicalTrials.gov ID：NCT03505866 ；发布日期：2018 年 4 月 20 日。
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