Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
HIV Res Clin Pract. 2020 Apr-Jun;21(2-3):45-55. doi: 10.1080/25787489.2020.1763711. Epub 2020 May 18.
We aimed to identify the association between stress and antiretroviral therapy (ART) adherence among women in HIV care in Toronto, Ontario participating in the Ontario HIV Treatment Network Cohort Study (OCS) between 2007 and 2012.
We conducted cross-sectional analyses with women on ART completing the AIDS Clinical Trial Group (ACTG) Adherence Questionnaire. Data closest to, or at the last completed interview, were collected from medical charts, through record linkage with Public Health Ontario Laboratories, and from a standardized self-reported questionnaire comprised of socio-demographic and psycho-socio-behavioral measures (Center for Epidemiologic Studies Depression Scale (CES-D), Alcohol Use Disorders Identification Test (AUDIT)), and stress measures (National Population Health Survey). Logistic regression was used to quantify associations with optimal adherence (≥95% adherence defined as missing ≤ one dose of ART in the past 4 weeks).
Among 307 women, 65.5% had optimal adherence. Women with suboptimal compared to optimal adherence had higher median total stress scores (6.0 [interquartile range (IQR): 3.0-8.1] vs. 4.1 [IQR: 2.0-7.1], p = 0.001), CES-D scores (16 [IQR: 6-28] vs. 12 [IQR: 3-22], p = 0.008) and reports of hazardous and harmful alcohol use (31.1% vs. 17.9%, p = 0.008). In our multivariable model, we found an increased likelihood of optimal adherence with the absence of hazardous and harmful alcohol use (Adjusted Odds Ratio (AOR)=2.20, 95% confidence interval (CI): 1.12-4.32) and a decreased likelihood of optimal adherence with more self-reported stress (AOR = 0.56, 95% CI: 0.33-0.94).
Interventions supporting optimal ART adherence should address stress and include strategies to reduce or eliminate hazardous and harmful alcohol use for women living with HIV.
我们旨在确定安大略省多伦多艾滋病毒护理中心的女性中压力与抗逆转录病毒治疗（ART）依从性之间的关联，这些女性参加了安大略省艾滋病毒治疗网络队列研究（OCS），时间为 2007 年至 2012 年。
我们对正在接受 ART 治疗并完成艾滋病临床试验组（ACTG）依从性问卷的女性进行了横断面分析。数据是从医疗记录中收集的，或通过与安大略省公共卫生实验室的记录链接收集的，或通过标准化的自我报告问卷收集的，该问卷包含社会人口学和心理社会行为措施（流行病学研究中心抑郁量表（CES-D），酒精使用障碍识别测试（AUDIT））和压力措施（国家人口健康调查）。使用逻辑回归来量化与最佳依从性（定义为过去 4 周内错过 ≤ 一剂量 ART 的最佳依从性为≥95%）的关联。
在 307 名女性中，65.5%的人有最佳依从性。与最佳依从性相比，依从性差的女性的中位总压力评分更高（6.0 [四分位距（IQR）：3.0-8.1] vs. 4.1 [IQR：2.0-7.1]，p=0.001），CES-D 评分（16 [IQR：6-28] vs. 12 [IQR：3-22]，p=0.008）和危险及有害饮酒报告（31.1% vs. 17.9%，p=0.008）。在我们的多变量模型中，我们发现无危险及有害饮酒的女性更有可能实现最佳依从性（调整后的优势比（AOR）=2.20，95%置信区间（CI）：1.12-4.32），而自我报告的压力更大的女性更不可能实现最佳依从性（AOR=0.56，95%CI：0.33-0.94）。
支持最佳 ART 依从性的干预措施应解决压力问题，并包括减少或消除艾滋病毒感染者中危险及有害饮酒的策略。
