Hussen Tale Abay, Tegegne Awoke Seyoum, Belay Denekew Bitew
Department of Statistics, Assosa University, Assosa, Ethiopia.
Department of Statistics, Bahir Dar University, Bahir Dar, Ethiopia.
HIV AIDS (Auckl). 2023 Aug 11;15:477-489. doi: 10.2147/HIV.S422980. eCollection 2023.
Maintaining good medication adherence and decreasing viral load in patients living with HIV/AIDS are critical to ensuring antiretroviral therapy's preventive and therapeutic benefits. The main objective of this study was to assess the predictors of viral load and medication adherence among HIV-positive adults under treatment at Felege Hiwot Comprehensive Specialized Hospital (FHCSH).
A retrospective cohort study design was conducted from a random sample of 281 adult HIV-infected patients under treatment at FHCSH in northwest Ethiopia from June 2017 to June 2021. Separate GLMM was used in analysis of viral load and medication adherence, and joint mode was applied to fit those two outcomes jointly. The potential correlation of those two outcomes was linked by random intercepts. Information criteria (AIC and BIC) were used for model comparison and covariance structure selection.
The small standard error of significant predictors and significant correlation between viral load and medication adherence over time provide evidence for joint model selection. The correlation between viral load and medication adherence was -0.7688 (-value=< 0.05), which indicates that the decrement of viral load tends to increase good medication adherence. Patient substance use, visit time, baseline CD4 cell, baseline hemoglobin, and the interaction of visit time by substance use were significantly associated with viral load and medication adherence jointly.
The study revealed that substance user adult patients, patients with low baseline CD4 cells, and patients with low baseline hemoglobin were with high viral loads and poor medication adherence. Therefore, health officials and other concerned bodies should give special attention and high intervention to patients with low baseline hemoglobin; poor adherence and low baseline CD4 cell count.
对于感染艾滋病毒/艾滋病的患者而言，维持良好的药物依从性并降低病毒载量对于确保抗逆转录病毒疗法的预防和治疗效果至关重要。本研究的主要目的是评估在费莱格·希沃特综合专科医院（FHCSH）接受治疗的HIV阳性成年患者中病毒载量和药物依从性的预测因素。
采用回顾性队列研究设计，从2017年6月至2021年6月在埃塞俄比亚西北部FHCSH接受治疗的281名成年HIV感染患者的随机样本中选取。分别使用广义线性混合模型（GLMM）分析病毒载量和药物依从性，并应用联合模型来共同拟合这两个结果。这两个结果的潜在相关性通过随机截距联系起来。信息准则（AIC和BIC）用于模型比较和协方差结构选择。
显著预测因素的小标准误差以及病毒载量和药物依从性随时间的显著相关性为联合模型选择提供了证据。病毒载量与药物依从性之间的相关性为-0.7688（P值<0.05），这表明病毒载量的降低往往会提高良好的药物依从性。患者的物质使用情况、就诊时间、基线CD4细胞、基线血红蛋白以及就诊时间与物质使用的相互作用与病毒载量和药物依从性均显著相关。
该研究表明，有物质使用问题的成年患者、基线CD4细胞低的患者以及基线血红蛋白低的患者病毒载量高且药物依从性差。因此，卫生官员和其他相关机构应特别关注并对基线血红蛋白低、依从性差和基线CD4细胞计数低的患者进行高度干预。
