School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. Mail Stop 0274, United States.
Department of Psychology, University of Nevada, Reno , 1664 N. Virginia St. Mail Stop 0296, United States.
Curr HIV Res. 2020;18(6):436-442. doi: 10.2174/1570162X18666200817112255.
Comorbidity rates and service needs are high among people living with HIV/AIDS (PLWHA). The effects of service utilization and unmet service needs on antiretroviral therapy (ART) adherence are not well understood. The purpose of this study was to investigate associations among PLWHA's service utilization, unmet service needs, and ART adherence.
PLWHA (N=162) 18 years or older were recruited from a Nevada statewide needs assessment project in 2016. Participants completed a self-administered questionnaire on paper or online. The independent variables were service utilization and unmet service needs. The outcome variable was ART adherence. Multivariable logistic regression analyses were conducted to examine associations between the amount of utilized services and unmet service needs with ART adherence.
Only 12 (7.5%) participants reported they received all the needed services. The ART nonadherence group showed significantly higher unmet medical service needs compared to the ART adherence group (p=0.007). Unmet medical service needs (Adjusted Odds Ratio (AOR) 0.69, CI 0.53-0.90) and unmet support service needs (AOR 0.68, CI 0.48-0.97) were negatively associated with ART adherence. However, utilizing medical services (AOR 1.06, CI 0.87-1.30) and support services (AOR 0.88, CI 0.74-1.04) in the current year were not significantly associated with ART adherence.
The results of this study indicate that health promotion programming should focus not only on introducing new services at the community level, but also work to optimize the availability and awareness of current services. Furthermore, health promotion programs should focus on filling service coverage gaps and improving the facilitation of services.
艾滋病毒/艾滋病（PLWHA）感染者的合并症发病率和服务需求较高。服务利用和未满足的服务需求对抗逆转录病毒治疗（ART）依从性的影响尚不清楚。本研究的目的是调查 PLWHA 的服务利用、未满足的服务需求和 ART 依从性之间的关联。
2016 年，从内华达州全州需求评估项目中招募了 18 岁或以上的 PLWHA（N=162）。参与者通过纸质或在线方式完成了一份自我管理的问卷。自变量为服务利用和未满足的服务需求。因变量为 ART 依从性。多变量逻辑回归分析用于检查利用服务的数量和未满足的服务需求与 ART 依从性之间的关联。
只有 12（7.5%）名参与者报告他们接受了所有需要的服务。与 ART 依从组相比，ART 不依从组的未满足医疗服务需求明显更高（p=0.007）。未满足的医疗服务需求（调整后的优势比（AOR）0.69，置信区间（CI）0.53-0.90）和未满足的支持服务需求（AOR 0.68，CI 0.48-0.97）与 ART 依从性呈负相关。然而，本年度利用医疗服务（AOR 1.06，CI 0.87-1.30）和支持服务（AOR 0.88，CI 0.74-1.04）与 ART 依从性无显著相关性。
本研究结果表明，健康促进计划不仅应侧重于在社区层面推出新服务，还应努力优化现有服务的可及性和知晓度。此外，健康促进计划应侧重于填补服务覆盖差距并改善服务的便利性。
