The British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
Faculty of Health Sciences, Simon Fraser University, Barnaby, British Columbia, Canada.
J Adolesc Health. 2019 Apr;64(4):509-515. doi: 10.1016/j.jadohealth.2018.10.001. Epub 2018 Dec 10.
We assessed differences in optimal adherence between youth (aged 15-29 years) and adults (aged ≥30 years) enrolled in the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program from 2010 to 2016.
Population-level clinical data were used to compare optimal antiretroviral therapy adherence (≥95%), based on pharmacy refill data, among youth and adults. Unadjusted and adjusted generalized estimating estimates were performed to examine the independent relationship between time-dependent age categories and optimal adherence, adjusting for confounders. Factors associated with optimal adherence among youth were examined.
Data for 7,485 individuals living with HIV were included. Median follow-up was 7 years (Q1-Q3: 4-7). Over the study period, the number of individuals categorized as "youth" ranged from 820 in 2010 to 291 in 2016. Multivariable models found youth living with HIV were significantly less likely to be optimally adherent than adults (adjusted odds ratio [aOR] = .55; 95% confidence interval [CI]: .49-.62), after controlling for potential confounders, although youth adherence improved significantly during the study period. Among youth, increasing time-dependent age (aOR = 1.18/year older; 95%CI: 1.11-1.25) and number of years on antiretroviral therapy (aOR = 1.15, 95%CI: 1.10-1.19) were independently associated with optimal adherence, while Hepatitis C-positive serostatus (aOR = .55; 95%CI: .33-.92) and multiple treatment regimen change (aOR = .89/regimen change; 95%CI: .81-.97) were negatively associated with optimal adherence.
Youth were less likely to be optimally adherent throughout the study period. Findings suggest implications for increased youth-centered adherence support, particularly for youth living with HIV concurrently living with Hepatitis C, newly initiating treatment, and going through medication change.
我们评估了 2010 年至 2016 年期间参加不列颠哥伦比亚省艾滋病病毒/艾滋病药物治疗卓越中心的青年（15-29 岁）和成年人（≥30 岁）之间最佳依从性的差异。
利用人群水平的临床数据，根据药房 refill 数据，比较青年和成年人中最佳抗逆转录病毒治疗依从性（≥95%）。使用广义估计方程，在调整混杂因素后，检查时间依赖性年龄类别与最佳依从性之间的独立关系。还检查了与青年最佳依从性相关的因素。
纳入了 7485 名 HIV 感染者的数据。中位随访时间为 7 年（Q1-Q3：4-7）。在研究期间，被归类为“青年”的人数从 2010 年的 820 人减少到 2016 年的 291 人。多变量模型发现，与成年人相比，HIV 感染者青年不太可能达到最佳依从性（调整后的优势比[aOR] = 0.55；95%置信区间[CI]：0.49-0.62），尽管在研究期间青年的依从性显著提高。在青年中，随着时间依赖性年龄的增加（aOR = 1.18/岁；95%CI：1.11-1.25）和抗逆转录病毒治疗年限的增加（aOR = 1.15，95%CI：1.10-1.19）与最佳依从性独立相关，而丙型肝炎病毒阳性血清阳性（aOR = 0.55；95%CI：0.33-0.92）和多次治疗方案改变（aOR = 0.89/方案改变；95%CI：0.81-0.97）与最佳依从性呈负相关。
在整个研究期间，青年人群不太可能达到最佳依从性。研究结果表明，需要增加以青年为中心的依从性支持，特别是对同时患有丙型肝炎病毒、新开始治疗和药物改变的 HIV 感染者青年。
