George S, McGrath N
a Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton , UK.
b Academic Unit of Primary Care and Population Sciences and Department of Social Statistics and Demography , University of Southampton , Southampton , UK.
AIDS Care. 2019 Jul;31(7):875-884. doi: 10.1080/09540121.2018.1549720. Epub 2018 Nov 25.
The World Health Organisation (WHO) recommends antiretroviral treatment (ART) initiation at human immunodeficiency virus (HIV) diagnosis. As ART programmes expand, addressing barriers to adherence is vital. Past mixed findings on the association between social support, stigma and non-disclosure with ART adherence highlights the need for further research. The primary aim of this study was to examine how these factors are associated with ART non-adherence in the six months after ART initiation. The secondary aim was to explore how other factors are associated with non-adherence. We conducted secondary analysis of prospective data from HIV-positive adults initiating ART. Social support, disclosure patterns, perceived stigma and other demographic factors were collected at ART initiation and six months follow-up. Logistic regression models were used to examine factors associated with self-reported ART non-adherence in the last six months and the last month before the six month follow-up ("recent"). Non-adherence in the last six months was twenty-five percent and recent non-adherence was nine percent. There was no association between non-adherence and social support, stigma or non-disclosure of HIV status. In the final model the odds of non-adherence in the last six months were significantly higher for those: with incomplete ART knowledge (aOR 2.10, 95%CI 1.21-3.66); who visited a healthcare provider for conditions other than HIV (aOR1.98, 95%CI 1.14-3.43); had higher CD4 counts at ART initiation (CD4 100-199:aOR 2.50, 95%CI 1.30-4.81; CD4 ≥ 200:aOR 2.85, 95%CI 1.10-7.40;referent CD4 < 100 cells/mm); had tested HIV-positive in the last year (aOR 2.00, 95%CI 1.10-3.72; referent testing HIV-positive outside the last year); experienced a rash/itching secondary to ART (aOR 2.48, 95%CI 1.37-4.52); and significantly lower for those ≥48 years (aOR 0.65, 95%CI 0.46-0.90). Early non-adherence remains a concern. Incorporation of adherence monitoring and ART knowledge enhancement into appointments for ART collection may be beneficial.
世界卫生组织（WHO）建议在诊断出人类免疫缺陷病毒（HIV）时即开始抗逆转录病毒治疗（ART）。随着ART项目的扩大，解决依从性障碍至关重要。过去关于社会支持、耻辱感以及不披露HIV感染状况与ART依从性之间关联的研究结果不一，这凸显了进一步研究的必要性。本研究的主要目的是调查这些因素在ART开始后的六个月内与ART不依从性之间的关联。次要目的是探索其他因素与不依从性之间的关联。我们对开始接受ART的HIV阳性成年人的前瞻性数据进行了二次分析。在ART开始时和六个月随访时收集了社会支持、披露模式、感知到的耻辱感及其他人口统计学因素。使用逻辑回归模型来研究与自我报告的在过去六个月以及六个月随访前最后一个月（“近期”）的ART不依从性相关的因素。过去六个月内的不依从率为25%，近期不依从率为9%。不依从性与社会支持、耻辱感或HIV感染状况的不披露之间无关联。在最终模型中，以下人群在过去六个月内不依从的几率显著更高：ART知识不完整者（调整后比值比[aOR]为2.10，95%置信区间[CI]为1.21 - 3.66）；因HIV以外的疾病就诊于医疗服务提供者的人（aOR为1.98，95%CI为1.14 - 3.43）；ART开始时CD4细胞计数较高者（CD4 100 - 199：aOR为2.50，95%CI为1.30 - 4.81；CD4≥200：aOR为2.85，95%CI为1.10 - 7.40；参照组CD4＜100个细胞/mm³）；在过去一年内检测出HIV阳性者（aOR为2.00，95%CI为1.10 - 3.72；参照组为过去一年以外检测出HIV阳性）；经历过ART继发的皮疹/瘙痒者（aOR为2.48，95%CI为1.37 - 4.52）；而年龄≥48岁者的不依从几率则显著更低（aOR为0.65，95%CI为0.46 - 0.90）。早期不依从性仍然令人担忧。将依从性监测和ART知识强化纳入ART药物领取预约中可能会有所帮助。
