坦桑尼亚一个城市艾滋病病毒护理与治疗中心抗逆转录病毒治疗不依从性的预测因素
Predictors of non adherence to antiretroviral therapy at an urban HIV care and treatment center in Tanzania.
作者信息
Sangeda Raphael Z, Mosha Fausta, Aboud Said, Kamuhabwa Appolinary, Chalamilla Guerino, Vercauteren Jurgen, Van Wijngaerden Eric, Lyamuya Eligius F, Vandamme Anne-Mieke
机构信息
Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania,
Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, KU Leuven - University of Leuven, Leuven, Belgium,
出版信息
Drug Healthc Patient Saf. 2018 Aug 21;10:79-88. doi: 10.2147/DHPS.S143178. eCollection 2018.
BACKGROUND
Measurement of adherence to antiretroviral therapy (ART) can serve as a proxy for virologic failure in resource-limited settings. The aim of this study was to determine the factors underlying nonadherence measured by three methods.
PATIENTS AND METHODS
This is a prospective longitudinal cohort of 220 patients on ART at Amana Hospital in Dar es Salaam, Tanzania. We measured adherence using a structured questionnaire combining a visual analog scale (VAS) and Swiss HIV Cohort Study Adherence Questionnaire (SHCS-AQ), pharmacy refill, and appointment keeping during four periods over 1 year. Overall adherence was calculated as the mean adherence for all time points over the 1 year of follow-up. At each time point, adherence was defined as achieving a validated cutoff for adherence previously defined for each method.
RESULTS
The proportion of overall adherence was 86.4% by VAS, 69% by SHCS-AQ, 79.8% by appointment keeping, and 51.8% by pharmacy refill. Forgetfulness was the major reported reason for patients to skip their medications. In multivariate analysis, significant predictors to good adherence were older age, less alcohol consumption, more advanced World Health Organization clinical staging, and having a lower body mass index with odds ratio (CI): 3.11 (1.55-6.93), 0.24 (0.09-0.62), 1.78 (1.14-2.84), and 0.93 (0.88-0.98), respectively.
CONCLUSION
We found relatively good adherence to ART in this setting. Barriers to adherence include young age and perception of well-being.
背景
在资源有限的环境中，测量抗逆转录病毒疗法（ART）的依从性可作为病毒学失败的替代指标。本研究的目的是确定通过三种方法测量的不依从背后的因素。
患者和方法
这是一项对坦桑尼亚达累斯萨拉姆阿马纳医院220名接受抗逆转录病毒治疗患者的前瞻性纵向队列研究。我们在1年的四个时间段内，使用结合视觉模拟量表（VAS）和瑞士艾滋病毒队列研究依从性问卷（SHCS-AQ）的结构化问卷、药房配药记录以及预约就诊情况来测量依从性。总体依从性计算为随访1年中所有时间点的平均依从性。在每个时间点，依从性定义为达到先前为每种方法定义的有效依从性临界值。
结果
通过VAS测量的总体依从性比例为86.4%，通过SHCS-AQ为69%，通过预约就诊为79.8%，通过药房配药记录为51.8%。遗忘是患者报告的漏服药物的主要原因。在多变量分析中，依从性良好的显著预测因素是年龄较大、饮酒较少、世界卫生组织临床分期较高以及体重指数较低，优势比（CI）分别为：3.11（1.55 - 6.93）、0.24（0.09 - 0.62）、1.78（1.14 - 2.84）和0.93（0.88 - 0.98）。
结论
我们发现在这种情况下对抗逆转录病毒疗法的依从性相对较好。依从性的障碍包括年轻和自我感觉良好。
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