使用复合依从性工具评估在启动选项 B 后 6 个月和 12 个月时，感染 HIV 的喀麦隆孕妇和哺乳期妇女的 ART 反应和不良依从性的风险因素。
Using a composite adherence tool to assess ART response and risk factors of poor adherence in pregnant and breastfeeding HIV-positive Cameroonian women at 6 and 12 months after initiating option B.
机构信息
Cameroon Baptist Convention Health Service (CBCHS), P. O. Box 152, Tiko, Health Services Complex, Mutengene, South West Region, Cameroon.
Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon.
出版信息
BMC Pregnancy Childbirth. 2018 Oct 25;18(1):418. doi: 10.1186/s12884-018-2058-9.
BACKGROUND
Antiretroviral therapy (ART) adherence in preventing HIV mother-to-child transmission in association with virological suppression and risk factors of low adherence in the Cameroon's Option B+ programme are poorly understood. We used a composite adherence score (CAS) to determine adherence and risk factors of poor adherence in association with virological treatment response in HIV-positive pregnant and breastfeeding women who remained in care at 6 and 12 months after initiating ART.
METHODS
We prospectively enrolled 268 women after ART initiation between October 2013 and December 2015 from five facilities within the Kumba health district. Adherence at 6 and 12 months were measured using a CAS comprising of a 6-month medication refill record review, a four-item self-reported questionnaires and a 30-day visual analogue scale. Adherence was defined as the sum scores of the three measures and classified as high, moderate and low. Measured adherence levels were compared to virological suppression rates at month 12 and risk factors of poor adherence were determined.
RESULTS
At 6 and 12 months, 217 (81.0%) and 185 (69.0%) women were available for adherence evaluation. Respectively. Of those, 128 (59.0%) and 68 (31.4%) had high or moderate adherence as per the CAS tool at month 6, and 116 (62.7%) and 48 (24.9%) at month 12, respectively. Viral loads were assessed in 165 women at months 12, and 92.7% had viral suppression (< 1000 copies/mL). Viral suppression was seen in 100% of women with high, 89.5% with moderate, and 52.9% with low adherence using the CAS tool. Virological treatment failure was significantly associated with low adherence [OR 7.6, (95%CI, 1.8-30.8)]. Risk factors for low adherence were younger age [aOR 3.8, (95%CI, 1.4-10.6)], primary as compared to higher levels of education [aOR 2.7, (95%CI, 1.4-5.2)] and employment in the informal sector compared to unemployment [aOR 1.9, (95%CI,1.0-3.6)].
CONCLUSIONS
During the first year of Option B+ implementation in Cameroon our novel CAS adherence tool was feasible, and useful to discriminate ART adherence levels which correlated with viral suppression. Younger age, less educated and informal sector employed women may need more attention for optimal adherence to reduce the risk of virological failure.
背景
在喀麦隆的“B 方案+”项目中，抗逆转录病毒疗法（ART）依从性与病毒学抑制以及低依从性的风险因素在预防母婴传播 HIV 方面的相关性了解甚少。我们使用综合依从性评分（CAS）来确定在开始 ART 后 6 个月和 12 个月时，仍在接受护理的 HIV 阳性孕妇和哺乳期妇女的依从性及其与病毒学治疗反应相关的不良依从性的风险因素。
方法
我们前瞻性地招募了 2013 年 10 月至 2015 年 12 月期间，来自 Kumba 卫生区的五个设施的 268 名女性。6 个月和 12 个月时的依从性使用综合依从性评分（CAS）来衡量，该评分包括 6 个月的药物补充记录审查、四项自我报告的调查问卷和 30 天的视觉模拟量表。依从性定义为三个测量指标的总和评分，并分为高、中、低。将测量的依从性水平与 12 个月时的病毒学抑制率进行比较，并确定不良依从性的风险因素。
结果
在 6 个月和 12 个月时，分别有 217（81.0%）和 185（69.0%）名女性可进行依从性评估。分别有 128（59.0%）和 68（31.4%）名女性在 6 个月时根据 CAS 工具具有高或中依从性，分别有 116（62.7%）和 48（24.9%）名女性在 12 个月时具有高或中依从性。在 165 名女性中评估了病毒载量，其中 92.7%有病毒抑制（<1000 拷贝/ml）。使用 CAS 工具，100%的高依从性、89.5%的中依从性和 52.9%的低依从性的女性均有病毒学抑制。病毒学治疗失败与低依从性显著相关[比值比 7.6（95%CI，1.8-30.8)]。低依从性的风险因素是年龄较小[aOR 3.8（95%CI，1.4-10.6)]，与较高的教育水平相比，基础教育[aOR 2.7（95%CI，1.4-5.2)]和从事非正规部门就业[aOR 1.9（95%CI，1.0-3.6)]。
结论
在喀麦隆实施“B 方案+”的第一年，我们的新型 CAS 依从性工具是可行的，并且可用于区分与病毒抑制相关的 ART 依从性水平。年龄较小、教育程度较低和从事非正规部门就业的女性可能需要更多关注以实现最佳依从性，以降低病毒学失败的风险。
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