西欧 HIV 感染者中抗逆转录病毒治疗不依从与相关因素分析。

Dose-related and contextual aspects of suboptimal adherence to antiretroviral therapy among persons living with HIV in Western Europe.

机构信息

Zatum LLC, Department of Epidemiology and Real-World Evidence Grand Blanc, MI, USA.

Ipsos Insights LLC, New York, NY, USA.

出版信息

Eur J Public Health. 2021 Jul 13;31(3):567-575. doi: 10.1093/eurpub/ckaa229.

DOI:10.1093/eurpub/ckaa229

PMID:33462616

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8277220/

Abstract

BACKGROUND

The daily oral dosing requirement for antiretroviral therapy (ART) may be challenging for some people living with HIV (PLWHIV) with comorbid conditions, confidentiality concerns or pill fatigue. We investigated suboptimal adherence from the perspective of PLWHIV and HIV physicians.

METHODS

PLWHIV on ART (n = 688) and HIV physicians (n = 120) were surveyed during 2019 in France, Germany, Italy and the UK. Suboptimal adherence was a report the participant missed taking their dose as prescribed 'Sometimes'/'Often'/'Very often'. Physicians' interest in offering a hypothetical long-acting HIV regimen for suboptimally adherent patients was assessed. Descriptive and multivariable analyses were performed (P < 0.05).

RESULTS

Of PLWHIV, 23.8% (164/688) reported suboptimal adherence vs. providers' estimated prevalence of 33.6% (SD = 28.8). PLWHIV-reported prevalence of specific suboptimal adherence behaviors were: mistimed dose [16.1% (111/688)]; missed a dose [15.7% (108/688)]; dosed under wrong conditions [e.g. food restrictions, 10.5% (72/688)] and overdosed [3.3% (23/688)]. Odds of suboptimal adherence were higher among those with vs. without a report of the following: dysphagia (AOR = 3.61, 95% CI = 2.28-5.74), stress/anxiety because of their daily dosing schedule (AOR = 3.09, 95% CI = 1.97-4.85), gastrointestinal side effects (AOR = 2.09, 95% CI = 1.39-3.15), neurocognitive/mental health conditions (AOR = 1.88, 95% CI = 1.30-2.72) or hiding their HIV medication (AOR = 1.51, 95% CI = 1.04-2.19). Of providers, 84.2% indicated they Definitely/Probably will offer a hypothetical long-acting HIV regimen 'for patients who have suboptimal levels of adherence to daily oral therapy (50-90%) for non-medical reasons'.

CONCLUSIONS

Dysphagia, stressful daily oral dosing schedule, gastrointestinal side effects, neurocognitive/mental health conditions and confidentiality concerns were associated with suboptimal adherence in our study. Adherence support and alternative regimens, such as long-acting antiretroviral therapies, could help address these challenges.

摘要

背景

对于一些合并症、保密性问题或药物疲劳的 HIV 感染者（PLWHIV），每日口服抗病毒治疗（ART）的剂量要求可能具有挑战性。我们从 PLWHIV 和 HIV 医生的角度研究了不依从治疗的情况。

方法

在 2019 年，法国、德国、意大利和英国的 688 名接受 ART 的 PLWHIV 和 120 名 HIV 医生参与了这项调查。不依从治疗是指参与者报告他们有时/经常/非常经常错过规定剂量。评估了医生对为依从性差的患者提供假设长效 HIV 治疗方案的兴趣。进行了描述性和多变量分析（P<0.05）。

结果

PLWHIV 中有 23.8%（164/688）报告不依从治疗，而提供者估计的患病率为 33.6%（SD=28.8）。PLWHIV 报告的具体不依从治疗行为的患病率为：定时剂量错误[16.1%（111/688）]；漏服[15.7%（108/688）]；错服[例如食物限制，10.5%（72/688）]和过量服用[3.3%（23/688）]。与没有以下情况的人相比，报告以下情况的人更有可能出现不依从治疗：吞咽困难（优势比[OR]=3.61，95%置信区间[CI]=2.28-5.74）；因每日服药计划而感到压力/焦虑（OR=3.09，95% CI=1.97-4.85）；胃肠道副作用（OR=2.09，95% CI=1.39-3.15）；神经认知/心理健康状况（OR=1.88，95% CI=1.30-2.72）；或隐瞒 HIV 药物（OR=1.51，95% CI=1.04-2.19）。在提供者中，84.2%表示他们肯定/可能会为依从性差的患者提供假设的长效 HIV 治疗方案（每日口服治疗依从率为 50-90%，非医学原因）。