在埃塞俄比亚东北部，二线抗逆转录病毒治疗中 PLHIV 药物依从性的卫生机构和个体水平特征的作用：多水平模型的应用。
The role of health facility and individual level characteristics on medication adherence among PLHIV on second-line antiretroviral therapy in Northeast Ethiopia: use of multi-level model.
机构信息
School of Public Health, CMHS, Wollo University, Dessie, Ethiopia.
School of Public Health, CMHS, Bahir Dar University, Bahir Dar, Ethiopia.
出版信息
AIDS Res Ther. 2022 Mar 26;19(1):17. doi: 10.1186/s12981-022-00441-8.
BACKGROUND
Medication adherence plays a pivotal role in achieving the desired treatment outcomes. The proportion of HIV patients on second-line antiretroviral therapy is becoming a growing public health concern. However, to date, little attention has been given to second-line antiretroviral medication adherence. Moreover, the association between health facility characteristics and medication adherence has yet not been tested. Thus, this research was conducted to determine the magnitude of medication adherence and examine the role of facility-level determinants among HIV patients on second-line ART.
METHODS
A cross-sectional study was conducted on 714 HIV patients on second-line therapy who were selected via systematic random sampling in twenty public health facilities. Medication adherence was measured using the six-item Simplified Medication Adherence Questionnaire (SMAQ) tool. Data were collected in a personal interview as well as document reviews. A multi-level binary logistic regression was used to uncover individual and facility-level determinants. The effect size was presented using an adjusted odds ratio (AOR), and statistical significance was declared at a P value less than 0.05.
RESULTS
The magnitude of optimal medication adherence among HIV patients on second-line antiretroviral therapy was 69.5% (65.9-72.7%). Medication adherence was positively associated with the use of adherence reminder methods [AOR = 3.37, (95% CI 2.03-5.62)], having social support [AOR = 1.11, (95% CI 1.02-1.23)], and not having clinical depression [AOR = 3.19, (95% CI 1.93-5.27). The number of adherence counselors [AOR = 1.20, (95% CI 1.04-1.40)], teamwork for enhanced adherence support [AOR = 1.82, (95% CI 1.01-3.42)], and caseloads at ART clinics were all significantly correlated with ARV medication adherence at the facility level.
CONCLUSIONS
A large proportion of HIV patients on second-line antiretroviral therapy had adherence problems. Both facility-level and individual-level were linked with patient medication adherence. Thus, based on the identified factors, individual and system-level interventions should be targeted.
背景
药物依从性在实现预期治疗效果方面起着关键作用。接受二线抗逆转录病毒治疗的艾滋病毒感染者比例正成为一个日益严重的公共卫生问题。然而，迄今为止，人们对二线抗逆转录病毒药物依从性关注甚少。此外，卫生机构特征与药物依从性之间的关系尚未得到检验。因此，本研究旨在确定药物依从性的程度，并检验二线抗逆转录病毒治疗的艾滋病毒感染者中与卫生机构相关的决定因素。
方法
本横断面研究通过系统随机抽样在 20 家公共卫生机构中选取了 714 名接受二线治疗的艾滋病毒感染者。采用简化用药依从性问卷（SMAQ）工具测量药物依从性。通过个人访谈和文件审查收集数据。采用多水平二项逻辑回归分析揭示个体和机构层面的决定因素。采用调整后的优势比（AOR）表示效应量，P 值小于 0.05 为差异有统计学意义。
结果
二线抗逆转录病毒治疗的艾滋病毒感染者中，最佳药物依从性的程度为 69.5%（65.9-72.7%）。药物依从性与使用依从性提醒方法呈正相关（AOR=3.37，95%CI 2.03-5.62）、获得社会支持（AOR=1.11，95%CI 1.02-1.23）和无临床抑郁（AOR=3.19，95%CI 1.93-5.27）。而药物依从性咨询师的数量（AOR=1.20，95%CI 1.04-1.40）、增强依从性支持的团队合作（AOR=1.82，95%CI 1.01-3.42）和艾滋病病毒治疗诊所的工作量与机构层面的抗逆转录病毒药物依从性显著相关。
结论
接受二线抗逆转录病毒治疗的艾滋病毒感染者中，很大一部分存在药物依从性问题。个体和机构层面均与患者药物依从性相关。因此，应根据确定的因素，针对个人和系统层面进行干预。
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