Bojan Kelly, Westfall Andrew O, Fernandez M Isabel, Martinez Jaime, Oyedele Temitope, Wilson Craig M, Hosek Sybil
Division of Adolescent and Young Adult Medicine, Ruth M. Rothstein CORE Center and Stroger Hospital of Cook County, Chicago, IL.
University of Alabama Birmingham, Birmingham, AL.
Vulnerable Child Youth Stud. 2019;14(2):142-150. doi: 10.1080/17450128.2019.1595798. Epub 2019 Apr 5.
HIV infections among adolescents and young adults continue to grow and clinical guidelines recommend the immediate start of life-saving antiretroviral therapy (ART). Unfortunately, suboptimal medication adherence among youth is common and can lead to poorer health outcomes as well as onward transmission of HIV to sexual partners. Clinical tools to assess treatment readiness are needed and can assist with adherence intervention strategies for youth. An assessment tool that we previously developed, the HIV Treatment Readiness Measure (HTRM), was administered to 595 HIV-positive youth ages 13-24 recruited from adolescent medicine clinics in the United States. Participants were followed for a minimum of 6 months and had to have at least one viral load test completed to be included in this analysis. The HTRM demonstrated high internal consistency (Chronbach's alpha = 0.86). For participants currently on ART at study entry, higher overall treatment readiness scores predicted future viral suppression (OR 1.52). Individual scores on three of the measure's factors (Psychosocial Issues, Connection with Care, and HIV Medication Beliefs) were also significant predictors of viral suppression. For those participants not on ART at study entry, the HIV Medication Beliefs factor significantly predicted who would eventually start ART (OR 2.26) but overall treatment readiness scores did not predict viral suppression in that group.
青少年和青年中的艾滋病毒感染人数持续增加,临床指南建议立即开始挽救生命的抗逆转录病毒疗法(ART)。不幸的是,年轻人中药物依从性欠佳的情况很常见,这可能导致健康状况较差,以及艾滋病毒向性伴侣的进一步传播。需要评估治疗准备情况的临床工具,这些工具可以协助制定针对年轻人的依从性干预策略。我们之前开发的一种评估工具——艾滋病毒治疗准备情况测量量表(HTRM),被应用于从美国青少年医学诊所招募的595名年龄在13至24岁的艾滋病毒呈阳性的年轻人。对参与者进行了至少6个月的随访,并且必须至少完成一次病毒载量检测才能纳入本分析。HTRM显示出较高的内部一致性(克朗巴哈系数α = 0.86)。对于在研究开始时正在接受抗逆转录病毒治疗的参与者,较高的总体治疗准备情况得分预示着未来的病毒抑制(比值比为1.52)。该测量量表的三个因素(心理社会问题、与医疗护理的联系以及艾滋病毒药物信念)的个体得分也是病毒抑制的重要预测指标。对于那些在研究开始时未接受抗逆转录病毒治疗的参与者,艾滋病毒药物信念因素显著预测了最终会开始接受抗逆转录病毒治疗的人(比值比为2.26),但总体治疗准备情况得分并未预测该组中的病毒抑制情况。