城市黑人男同性恋和双性恋者（MSM）中的心理困扰与抗逆转录病毒疗法或暴露前预防方案的依从性。
Psychological distress and adherence to anti-retroviral therapy or pre-exposure prophylaxis regimens among Urban Black gay and bisexual men (MSM).
机构信息
Krieger School of Arts and Sciences, 1466Johns Hopkins University, Baltimore, MD, USA.
Center for Child and Community Health Research (CCHR), Department of Pediatrics, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA.
出版信息
Int J STD AIDS. 2022 Oct;33(11):1005-1012. doi: 10.1177/09564624221123466. Epub 2022 Aug 26.
BACKGROUND
Urban Black gay, and bisexual men (MSM) bear a disproportionate burden of HIV in the U.S. Mental health is a barrier to adherence to both antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP). The objective was to determine the association between psychological distress and ART or PrEP adherence among urban Black MSM.
METHODS
Using data from a four-year prospective cohort study, adherence to ART was defined as > 95% and PrEP was defined as > 80% of doses taken in the past 30 days. Psychological distress measures included difficulty sleeping; feeling anxious; suicidality; feeling sad or depressed; feeling sick, ill, or not well in the past 3 months; high (vs. low) overall psychological distress was classified as above the median value. Associations were examined using Chi-square, Fisher's exact tests, and logistic regression.
RESULTS
Among 165 Black MSM, 44.2% (73) reported high psychological distress. 65.3% (47/72) of participants living with HIV and 39.8% (37/93) of HIV negative participants were ART or PrEP adherent, respectively. Education was significantly associated with PrEP adherence ( = 0.038). Non-injection drug use in the past 3 months ( = 0.008), difficulty sleeping ( = 0.010), feeling anxious ( = 0.003), and feeling sad or depressed ( < 0.001), and overall psychological distress ( < 0.001) were significantly associated with ART adherence. High psychological distress was significantly associated with a reduced odds of ART adherence (aOR 0.23; 95% CI = 0.08-0.70) adjusting for age and non-injection drug use.
CONCLUSIONS
Increased psychological distress was significantly associated with ART nonadherence and may represent an important barrier to viral suppression.
背景
美国城市中，黑人性少数群体男同性恋者、双性恋者（MSM）感染艾滋病毒的比例过高。心理健康是他们坚持接受抗逆转录病毒疗法（ART）和暴露前预防（PrEP）的障碍。本研究旨在确定城市黑人性少数群体男同性恋者的心理困扰与接受抗逆转录病毒治疗（ART）和接受暴露前预防（PrEP）的关系。
方法
本研究使用了一项为期四年的前瞻性队列研究的数据，将接受抗逆转录病毒治疗的患者定义为在过去 30 天内接受超过 95%的药物剂量，将接受暴露前预防的患者定义为在过去 30 天内接受超过 80%的药物剂量。心理困扰的衡量标准包括睡眠困难、焦虑、自杀意念、悲伤或抑郁、过去 3 个月内身体不适、整体心理困扰高（与低相比），分为高于中位数的水平。采用卡方检验、Fisher 精确检验和逻辑回归检验进行关联分析。
结果
在 165 名黑人男同性恋者中，44.2%（73 人）报告存在较高的心理困扰。在 HIV 阳性的参与者中，65.3%（47/72）接受了抗逆转录病毒治疗或接受了暴露前预防，而 HIV 阴性的参与者中，39.8%（37/93）接受了抗逆转录病毒治疗或接受了暴露前预防。教育程度与接受暴露前预防显著相关（ = 0.038）。在过去 3 个月内非注射吸毒（ = 0.008）、睡眠困难（ = 0.010）、焦虑（ = 0.003）和悲伤或抑郁（ < 0.001），以及整体心理困扰（ < 0.001）与接受抗逆转录病毒治疗显著相关。高心理困扰与接受抗逆转录病毒治疗的几率降低显著相关（调整年龄和非注射吸毒因素后，比值比为 0.23；95%置信区间为 0.08-0.70）。
结论
心理困扰增加与接受抗逆转录病毒治疗的不依从显著相关，可能是病毒抑制的重要障碍。
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