Alvi Yasir, Khalique Najam, Ahmad Anees, Khan Haroon Subhan, Faizi Nafis
Department of Community Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
Department of Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
Indian J Community Med. 2019 Apr-Jun;44(2):118-124. doi: 10.4103/ijcm.IJCM_164_18.
With the availability of antiretroviral therapy (ART) and subsequent change in the HIV/AIDS disease dynamic to a chronic manageable disease, adherence studies have received increasing attention. However, there is a paucity of studies that have considered World Health Organization (WHO) dimensions of adherence to ART. Therefore, this study was conducted with the objectives of determining the prevalence of adherence and the association of various factors across five WHO dimensions to adherence.
A cross-sectional study was carried out at the ART Centre, Aligarh. A total of 440 adult patients, taking treatment from the ART Centre, Aligarh were selected. A self-reported instrument of missing pills was used to measure adherence. Various factors across five WHO dimensions were studied.
Prevalence of adherence in our study was 81.3%. Among the five dimensions of adherence, distance from home (odds ratio [OR] 0.980; 95% confidence interval [CI] 0.964-0.997) among socioeconomic determinants, frequent adherence counseling (OR 8.737; 95% CI 4.076-18.727) among health system-related, drug regimen (OR 2.202; 95% CI 1.023-4.738) and absence of side effects (OR 3.293; 95% CI 1.473-7.365) among therapy related, absence of substance abuse (OR 2.747; 95% CI 1.209-6.243), and perceived change in health status (OR 4.196; 95% CI 1.613-10.915) among patient-related dimension were found to be significantly associated with adherence to ART, while clinical condition dimension did not play a significant role.
The ART adherence rate is still below satisfactory levels for long-term viral load suppression. WHO multidimensional approach - which was found to be quite relevant in our study setting - could be applied to effectively solve the adherence problem in our country.
随着抗逆转录病毒疗法（ART）的出现以及随后人类免疫缺陷病毒/获得性免疫综合征（HIV/AIDS）疾病动态转变为一种可慢性控制的疾病，依从性研究受到了越来越多的关注。然而，很少有研究考虑世界卫生组织（WHO）提出的ART依从性的各个方面。因此，本研究旨在确定依从性的患病率以及WHO五个维度中各种因素与依从性之间的关联。
在阿里格尔的ART中心开展了一项横断面研究。共选取了440名在阿里格尔ART中心接受治疗的成年患者。使用一份自我报告的漏服药物量表来衡量依从性。研究了WHO五个维度中的各种因素。
本研究中的依从性患病率为81.3%。在依从性的五个维度中，社会经济决定因素中的离家距离（优势比[OR]0.980；95%置信区间[CI]0.964 - 0.997）、卫生系统相关因素中的频繁依从性咨询（OR 8.737；95%CI 4.076 - 18.727）、治疗相关因素中的药物治疗方案（OR 2.202；95%CI 1.023 - 4.738）和无副作用（OR 3.293；95%CI 1.473 - 7.365）、患者相关因素中的无药物滥用（OR 2.747；95%CI 1.209 - 6.243）以及健康状况感知变化（OR 4.196；95%CI 1.613 - 10.915）被发现与ART依从性显著相关，而临床状况维度未发挥显著作用。
对于长期抑制病毒载量而言，ART依从率仍低于理想水平。在我们的研究环境中发现非常相关的WHO多维度方法，可应用于有效解决我国的依从性问题。
