在非洲队列研究中，对 HIV 护理的满意度及其与抗逆转录病毒治疗和病毒抑制的依从性的关联。
Perceived satisfaction with HIV care and its association with adherence to antiretroviral therapy and viral suppression in the African Cohort Study.
机构信息
HJF Medical Research International, Mbeya, Tanzania.
U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
出版信息
AIDS Res Ther. 2021 Nov 25;18(1):89. doi: 10.1186/s12981-021-00414-3.
BACKGROUND
Increased availability of HIV care over the past decade has dramatically reduced morbidity and mortality among people living with HIV (PLWH) in sub-Saharan Africa. However, perceived and experienced barriers to care, including dissatisfaction with services, may impact adherence and viral suppression. We examined the associations between satisfaction with HIV care and antiretroviral therapy (ART) adherence and viral load suppression.
METHODS
The African Cohort Study (AFRICOS) is a prospective observational study conducted at PEPFAR-supported clinics in four African countries. At enrollment and twice-yearly study visits, participants received a clinical assessment and a socio-behavioral questionnaire was administered. Participants were classified as dissatisfied with care if they reported dissatisfaction with any of the following: waiting time, health care worker skills, health care worker attitudes, quality of clinic building, or overall quality of care received. Robust Poisson regression was used to estimate prevalence ratios and 95% confidence intervals (CIs) for associations between satisfaction with care and ART adherence and between satisfaction with care and viral suppression (viral load < 1000 copies/mL).
RESULTS
As of 1 March 2020, 2928 PLWH were enrolled and 2311 had a year of follow-up visits. At the first annual follow-up visit, 2309 participants responded to questions regarding satisfaction with quality of care, and 2069 (89.6%) reported satisfaction with care. Dissatisfaction with waiting time was reported by 177 (7.6%), building quality by 59 (2.6%), overall quality of care by 18 (0.8%), health care worker attitudes by 16 (0.7%), and health care worker skills by 15 (0.7%). After adjusting for age and site, there was no significant difference in viral suppression between those who were satisfied with care and those who were dissatisfied (aPR: 1.03, 95% CI 0.97-1.09). Satisfaction with HIV care was moderately associated with ART adherence among AFRICOS participants (aPR: 1.09; 95% CI 1.00-1.16).
CONCLUSIONS
While patient satisfaction in AFRICOS was high and the association between perceived quality of care and adherence to ART was marginal, we did identify potential target areas for HIV care improvement, including reducing clinic waiting times.
背景
过去十年中，艾滋病毒护理服务的可及性提高，大大降低了撒哈拉以南非洲地区艾滋病毒感染者（PLWH）的发病率和死亡率。然而，对护理的认知和体验障碍，包括对服务的不满，可能会影响患者的服药依从性和病毒抑制率。我们研究了对艾滋病毒护理的满意度与抗逆转录病毒治疗（ART）依从性和病毒载量抑制之间的关联。
方法
非洲队列研究（AFRICOS）是一项在四个非洲国家的美国国际开发署支持的诊所中进行的前瞻性观察性研究。在入组和每两年一次的研究访视时，参与者接受了临床评估，并进行了社会行为问卷调查。如果参与者报告对以下任何方面不满意，则将其归类为对护理不满意：等待时间、医护人员技能、医护人员态度、诊所建筑质量或整体护理质量。使用稳健泊松回归估计满意度与 ART 依从性之间以及满意度与病毒抑制之间（病毒载量<1000 拷贝/毫升）的关联的患病率比和 95%置信区间（CI）。
结果
截至 2020 年 3 月 1 日，共纳入 2928 名 PLWH，其中 2311 名有一年的随访。在第一次年度随访时，有 2309 名参与者回答了有关护理质量满意度的问题，其中 2069 名（89.6%）报告对护理满意。177 名（7.6%）报告对等待时间不满意，59 名（2.6%）对建筑质量不满意，18 名（0.8%）对整体护理质量不满意，16 名（0.7%）对医护人员态度不满意，15 名（0.7%）对医护人员技能不满意。在调整年龄和地点后，对护理满意的人与对护理不满意的人之间的病毒抑制率没有显著差异（调整后的患病率比：1.03，95%CI 0.97-1.09）。在 AFRICOS 参与者中，对艾滋病毒护理的满意度与 ART 依从性中度相关（调整后的患病率比：1.09；95%CI 1.00-1.16）。
结论
尽管 AFRICOS 中的患者满意度较高，且感知到的护理质量与 ART 依从性之间的关联处于边缘水平，但我们确实确定了艾滋病毒护理改善的潜在目标领域，包括减少诊所等待时间。
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