Inoue Yoji, Oka Shinichi, Yokoyama Seiji, Hasegawa Koichi, Mahlich Jörg, Schaede Ulrike, Habuka Noriyuki, Murata Yoko
Graduate School of Health Care and Nursing, Juntendo University, Chiba 2790023, Japan.
AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo 1628655, Japan.
Healthcare (Basel). 2023 Feb 4;11(4):451. doi: 10.3390/healthcare11040451.
Long-term medical care for people living with HIV (PLHIV) is critical for treatment efficacy, and various studies have examined reasons for antiretroviral therapy (ART) non-adherence. In Japan, doctors assume patients maintain high adherence. However, little is known about real-world treatment adherence. We conducted an anonymous self-administered web-based survey asking about adherence for a total of 1030 Japanese PLHIV who were currently on ART. Adherence was determined using the eight-item Morisky Medication Adherence Scale (MMAS-8), for which scoring ranged from 0 to 8 and scores < 6 points were classified as low adherence. Data were analyzed based on patient-related factors; therapy-related factors; condition-related factors, such as a comorbidity with depression (utilizing the Patient Health Questionnaire 9, PHQ-9); and healthcare/system-related factors. Among 821 PLHIV who responded to the survey, 291 responders (35%) were identified as being in the low adherence group. A statistically significant relationship was found between the number of missed anti-HIV drug doses within the previous 2 weeks and long-term adherence, per the MMAS-8 score ( < 0.001). Risk factors for low adherence included age (younger than 21 years, = 0.001), moderate to severe depression ( = 0.002, using the PHQ-9), and drug dependence ( = 0.043). Adherence was also influenced by a shared decision-making process, including treatment selection, doctor-patient relations, and treatment satisfaction. Adherence was mainly affected by treatment decision factors. Hence, support of care providers should be considered critical for improving adherence.
为感染艾滋病毒者（PLHIV）提供长期医疗护理对治疗效果至关重要，并且已有多项研究探讨了抗逆转录病毒疗法（ART）治疗依从性不佳的原因。在日本，医生通常认为患者能保持较高的依从性。然而，对于实际治疗依从性情况却知之甚少。我们开展了一项基于网络的匿名自填式调查，询问了1030名正在接受抗逆转录病毒治疗的日本艾滋病毒感染者的治疗依从性情况。使用八项版的莫里isky药物依从性量表（MMAS-8）来确定依从性，该量表评分范围为0至8分，得分低于6分被归类为低依从性。我们根据患者相关因素、治疗相关因素、病情相关因素（如是否合并抑郁症，采用患者健康问卷9，即PHQ-9）以及医疗保健/系统相关因素对数据进行了分析。在821名回复调查的艾滋病毒感染者中，291名回复者（35%）被确定为低依从性组。根据MMAS-8评分，在前两周内漏服抗艾滋病毒药物的次数与长期依从性之间存在统计学上的显著关联（<0.001）。低依从性的风险因素包括年龄（21岁以下，=0.001）、中度至重度抑郁症（=0.002，采用PHQ-9）以及药物依赖（=0.043）。共同决策过程，包括治疗选择、医患关系和治疗满意度，也会影响依从性。依从性主要受治疗决策因素的影响。因此，护理提供者的支持对于提高依从性至关重要。
