Acharya Shrikala, Parthasarathy M, Palkar Amol, Keskar Padmaja, Setia Maninder Singh
Mumbai Districts AIDS Control Society, Mumbai, Maharashtra, India.
LINKAGES, FHI360, Delhi, India.
Indian J Dermatol. 2021 Jul-Aug;66(4):378-385. doi: 10.4103/ijd.IJD_640_20.
Poor adherence to antiretroviral therapy (ART) is associated with poor virologic control and drug resistance in people living with HIV/AIDS. Some barriers to ART adherence are cost, lack of information, stigma, or dissatisfaction with health services.
To study the association between barriers for ART adherence and viral suppression, and explore the role of "missing ART dose" as a potential mediator in high-risk groups.
Demographic, clinical, and behavioral data from 50 "virally suppressed" (viral load [VL] <1000 copies/ml) and 48 "not suppressed" (VL > 1000 copies/ml) individuals belonging to the key population in Mumbai were collected. Sociodemographic, behavioral, and other characteristics were compared, and mediation analysis was used to identify the mediator in the pathway to viral suppression.
Those who had missed their ART at least once in the past three months (37% versus 60%, = 0.03) and stayed alone were less likely to be virally suppressed (31% versus 69%, = 0.002). Individuals who had negative perception about ART (adjusted odds ratio [aOR]: 0.11, 95% confidence interval [CI]: 0.02, 0.47; = 0.002), poor ART-related knowledge/behaviors (aOR: 0.14, 95% CI: 0.03, 0.60; = 0.007), and poor pill taking practices (aOR: 0.10, 95% CI: 0.02, 0.61; = 0.01) were significantly less likely to be virally suppressed. The mediation pathway "adherence theme > missed ART in the past three months > viral suppression" was significant in these themes.
The factors associated with low viral suppression were knowledge/behaviors, perceptions about ART, and poor pill taking practices. Thus, it is important to provide correct information about ART, its effects, side effects, and potential limitations to marginalized population. Involving brothel keepers and (head of male-to-female transgendered people/ clans), and technology enabled customized counseling sessions will be helpful.
对抗逆转录病毒疗法（ART）依从性差与艾滋病毒/艾滋病感染者病毒学控制不佳和耐药性有关。ART依从性的一些障碍包括成本、信息缺乏、耻辱感或对医疗服务的不满。
研究ART依从性障碍与病毒抑制之间的关联，并探讨“漏服ART药物剂量”在高危人群中作为潜在中介因素的作用。
收集了孟买关键人群中50名“病毒得到抑制”（病毒载量[VL]<1000拷贝/毫升）和48名“未得到抑制”（VL>1000拷贝/毫升）个体的人口统计学、临床和行为数据。比较了社会人口统计学、行为和其他特征，并采用中介分析来确定病毒抑制途径中的中介因素。
在过去三个月中至少漏服一次ART药物的人（37%对60%，P = 0.03）以及独居者病毒得到抑制的可能性较小（31%对69%，P = 0.002）。对ART持负面看法的个体（调整后的优势比[aOR]：0.11，95%置信区间[CI]：0.02，0.47；P = 0.002）、ART相关知识/行为较差的个体（aOR：0.14，95%CI：0.03，0.60；P = 0.007）以及服药习惯较差的个体（aOR：0.10，95%CI：0.02，0.61；P = 0.01）病毒得到抑制的可能性显著较低。“依从性主题>过去三个月漏服ART药物>病毒抑制”这一中介途径在这些主题中具有显著性。
与病毒抑制率低相关的因素包括知识/行为、对ART的看法以及服药习惯较差。因此，向边缘化人群提供有关ART及其效果、副作用和潜在局限性的正确信息非常重要。让妓院老板和（男变女跨性别者/群体的头目）参与进来，以及采用技术实现定制化咨询服务会有所帮助。
