Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA.
Department of Community Health and Health Behavior, University of Buffalo, Buffalo, NY, USA.
AIDS Res Ther. 2023 Jun 29;20(1):42. doi: 10.1186/s12981-023-00538-8.
BACKGROUND: Poor adherence and under-utilization of antiretroviral therapy (ART) services have been major setbacks to achieving 95-95-95 policy goals in Sub-Saharan Africa. Social support and mental health challenges may serve as barriers to accessing and adhering to ART but are under-studied in low-income countries. The purpose of this study was to examine the association of interpersonal support and depression scores with adherence to ART among persons living with HIV (PLWH) in the Volta region of Ghana. METHODS: We conducted a cross-sectional survey among 181 PLWH 18 years or older who receive care at an ART clinic between November 2021 and March 2022. The questionnaire included a 6-item simplified ART adherence scale, the 20-item Center for Epidemiologic Studies Depression Scale (CES-D), and the 12-item Interpersonal Support Evaluation List-12 (ISEL-12). We first used a chi-squared or Fisher's exact test to assess the association between these and additional demographic variables with ART adherence status. We then built a stepwise multivariable logistic regression model to explain ART adherence. RESULTS: ART adherence was 34%. The threshold for depression was met by 23% of participants, but it was not significantly associated with adherence in multivariate analysis(p = 0.25). High social support was reported by 48.1%, and associated with adherence (p = 0.033, aOR = 3.45, 95% CI = 1.09-5.88). Other factors associated with adherence included in the multivariable model included not disclosing HIV status (p = 0.044, aOR = 2.17, 95% CI = 1.03-4.54) and not living in an urban area (p = 0.00037, aOR = 0.24, 95% CI = 0.11-0.52). CONCLUSION: Interpersonal support, rural residence, and not disclosing HIV status were independent predictors of adherence to ART in the study area.
背景:在撒哈拉以南非洲,抗逆转录病毒疗法(ART)服务的依从性差和利用率低是实现 95-95-95 政策目标的主要障碍。社会支持和心理健康挑战可能成为获得和坚持接受 ART 治疗的障碍,但在低收入国家研究不足。本研究旨在探讨人际支持和抑郁评分与加纳沃尔特地区接受 HIV 治疗的患者(PLWH)对 ART 的依从性之间的关系。
方法:我们对 2021 年 11 月至 2022 年 3 月期间在一家 ART 诊所接受护理的 181 名 18 岁或以上的 PLWH 进行了横断面调查。问卷包括一个 6 项简化的 ART 依从性量表、20 项流行病学研究中心抑郁量表(CES-D)和 12 项人际支持评估清单-12(ISEL-12)。我们首先使用卡方检验或 Fisher 精确检验评估这些变量与 ART 依从性状态之间的关联,以及其他人口统计学变量。然后,我们构建了一个逐步多变量逻辑回归模型来解释 ART 依从性。
结果:ART 依从性为 34%。23%的参与者达到了抑郁的阈值,但在多变量分析中与依从性无显著关联(p=0.25)。48.1%的人报告了较高的社会支持,与依从性相关(p=0.033,优势比 OR=3.45,95%置信区间 CI=1.09-5.88)。多变量模型中与依从性相关的其他因素包括未披露 HIV 状态(p=0.044,优势比 OR=2.17,95%置信区间 CI=1.03-4.54)和未居住在城市地区(p=0.00037,优势比 OR=0.24,95%置信区间 CI=0.11-0.52)。
结论:在研究区域,人际支持、农村居住和不披露 HIV 状态是 ART 依从性的独立预测因素。
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