Faculty of Medicine, Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia.
Postgraduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
AIDS Patient Care STDS. 2020 Feb;34(2):81-91. doi: 10.1089/apc.2019.0278.
The lifetime use of combination antiretroviral therapy (cART) highlights the need to understand patterns of and factors associated with adherence to cART. In this cohort study using a 10% random sample of dispensing claims data for eligible Australians, we identified 2042 people dispensed cART between January 2016 and December 2017 (mean age 48.0 ± 12.0 years old, 88.6% male, and 85.9% treatment experienced). We considered people to be adherent if the proportion of treatment coverage days was ≥80% in the 360 days after their first observed cART dispensing. We also used group-based trajectory modeling (GBTM) to examine different patterns of adherence for 360 days from first observed cART dispensing. Most commonly, people receiving cART were treated with two nucleoside/nucleotide reverse transcriptase inhibitors with an integrase strand transfer inhibitors (INSTI-46.6%). Overall, 1708 people [83.6% (95% confidential interval 82.0-85.3%)] remained adherent over 360 days. GBTM identified three distinct adherence patterns: nearly always adherent [67.8% (63.7-71.9%) of the cohort], moderate adherence [26.6% (23.0-30.1%)], and low adherence [5.6% (4.1-7.2%)]. People were more likely to belong to the "nearly always adherent" trajectory if they were older (per additional year of age), treated with an INSTI regimen, and on treatment for more than 6 months. Our study demonstrates that the 360-day adherence to cART is generally high, but approximately one-third maintain a moderate or low adherence pattern. The use of INSTI regimens and additional support of treatment adherence, especially among younger people and those initiating therapy, may further improve adherence.
终身使用联合抗逆转录病毒疗法 (cART) 凸显了人们需要了解坚持使用 cART 的模式和相关因素。在这项使用符合条件的澳大利亚人配药数据的 10%随机样本的队列研究中，我们确定了 2042 名在 2016 年 1 月至 2017 年 12 月期间接受 cART 治疗的人（平均年龄为 48.0±12.0 岁，88.6%为男性，85.9%为治疗经验丰富者）。我们认为，如果在首次观察到 cART 配药后的 360 天内，治疗覆盖率天数的比例≥80%，则患者具有依从性。我们还使用基于群组的轨迹建模（GBTM）来检查从首次观察到 cART 配药的 360 天内不同的依从模式。接受 cART 治疗的患者最常使用两种核苷/核苷酸逆转录酶抑制剂联合整合酶链转移抑制剂（INSTI-46.6%）。总体而言，1708 名患者[83.6%（95%置信区间 82.0-85.3%）]在 360 天内保持依从性。GBTM 确定了三种不同的依从模式：几乎总是依从[队列中 67.8%（63.7-71.9%）]，中等依从[26.6%（23.0-30.1%）]和低依从[5.6%（4.1-7.2%）]。如果患者年龄较大（每增加 1 岁）、接受 INSTI 治疗方案和治疗时间超过 6 个月，则更有可能属于“几乎总是依从”的轨迹。我们的研究表明，cART 的 360 天依从率总体较高，但约三分之一的患者保持中等或低依从模式。使用 INSTI 治疗方案和额外的治疗依从性支持，特别是在年轻人和开始治疗的人群中，可能会进一步提高依从性。
