超越抗逆转录病毒治疗：在 COVID-19 大流行期间和之前，患有多种慢性疾病的 HIV 患者复合药物治疗依从性的模式和相关因素。
Beyond Antiretroviral Treatment: Patterns and Factors Associated With Composite Medication Adherence Before and During the COVID-19 Pandemic in Patients With HIV With Multiple Chronic Conditions.
机构信息
Mid-Atlantic Permanente Research Institute (MAPRI), Rockville, MD.
出版信息
J Acquir Immune Defic Syndr. 2023 Apr 15;92(5):405-413. doi: 10.1097/QAI.0000000000003154.
BACKGROUND
Polypharmacy for multiple chronic conditions (MCCs) poses an increasing challenge in people with HIV (PWH). This research explores medication adherence in PWH with MCCs before and during COVID-19.
SETTING
Kaiser Permanente Mid-Atlantic States.
METHODS
Medical and pharmacy records of a continuously enrolled cohort (September 2018-September 2021) of adult PWH were used. To estimate medication adherence, monthly proportion of days covered (PDC) was measured individually for antiretrovirals (ARVs), diabetes medications (DMs), renin-angiotensin antagonists (RASMs), and statins (SMs) and combined into composite measures (CMs) with and without ARVs. Descriptive statistics, time-series models, and multivariable population-averaged panel general estimating equations were used to profile trends, effects, and factors associated with adherence.
RESULTS
The cohort (n = 543) was predominantly 51-64 years old (59.3%), Black (73.1%), male (69.2%), and commercially insured (65.4%). Two-thirds (63.7%) of patients were taking medications in 2 medication groups (ie, ARVs and either DMs, RASMs, or SMs), 28.9% were taking medications in 3 medication groups, and 7.4% were taking medications in all 4 medication groups. Overall, PDC for CMs without ARVs was 77.2% and 70.2% with ARVs. After March 2020, negative monthly trends in PDC were observed for CMs without ARVs (β = -0.1%, P = 0.003) and with ARVs (β = -0.3%, P = 0.001). For CMs with ARVs, Black race (aOR = 0.5; P < 0.001; ref: White) and taking medications for 3 medication groups (aOR = 0.8; P < 0.02; ref: 2) were associated with lower adherence.
CONCLUSION
Decreasing medication adherence trends were observed during the COVID-19 pandemic with variations among population subgroups. Opportunity exists to improve medication adherence for non-White populations and those taking medications for MCCs beyond ARVs.
背景
多种慢性疾病（MCCs）的多药治疗对艾滋病毒感染者（PWH）构成了日益严峻的挑战。本研究探讨了 COVID-19 之前和期间 PWH 合并 MCC 时的药物依从性。
地点
凯撒永久中大西洋州。
方法
使用连续入组队列（2018 年 9 月至 2021 年 9 月）的成年 PWH 的医疗和药房记录。为了估计药物依从性，分别测量抗逆转录病毒药物（ARVs）、糖尿病药物（DMs）、肾素-血管紧张素拮抗剂（RASMs）和他汀类药物（SMs）的每月比例天数覆盖（PDC），并组合成包含和不包含 ARVs 的综合指标（CMs）。使用描述性统计、时间序列模型和多变量人群平均面板广义估计方程来描述趋势、影响和与依从性相关的因素。
结果
队列（n=543）主要为 51-64 岁（59.3%）、黑人（73.1%）、男性（69.2%）和商业保险（65.4%）。三分之二（63.7%）的患者服用两种药物组的药物（即 ARVs 和 DMs、RASMs 或 SMs 之一），28.9%的患者服用三种药物组的药物，7.4%的患者服用所有四种药物组的药物。总体而言，不包含 ARVs 的 CMs 的 PDC 为 77.2%，包含 ARVs 的 PDC 为 70.2%。2020 年 3 月后，观察到不包含 ARVs 的 CMs 的 PDC 呈每月负向趋势（β=-0.1%，P=0.003）和包含 ARVs 的 CMs 的 PDC 呈每月负向趋势（β=-0.3%，P=0.001）。对于包含 ARVs 的 CMs，黑人种族（优势比[OR]=0.5；P<0.001；参考：白人）和服用三种药物组的药物（OR=0.8；P<0.02；参考：2）与较低的依从性相关。
结论
在 COVID-19 大流行期间，观察到药物依从性呈下降趋势，人群亚组之间存在差异。为非白人人群和服用 ARVs 以外的 MCC 药物的人群改善药物依从性提供了机会。
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