Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, No. 160 Qunxian Road, Panyu District Guangzhou, Guangzhou, China.
Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, 510310, China.
BMC Public Health. 2024 May 20;24(1):1358. doi: 10.1186/s12889-024-18774-6.
Understanding factors associated with antiretroviral treatment (ART) adherence is crucial for ART success among people living with HIV (PLHIV) in the "test and treat" era. Multiple psychosocial factors tend to coexist and have a syndemic effect on ART adherence. We aimed to explore factors associated with ART adherence and the syndemic effect of multiple psychosocial factors on ART adherence among PLHIV newly starting ART in Guangdong Province, China.
Newly diagnosed PLHIV from six cities in Guangdong Province were recruited between May 2018 and June 2019, and then followed up from May 2019 to August 2020. Baseline and follow-up data were collected from a questionnaire and the national HIV surveillance system, the follow-up data of which were analyzed in this study. A Center for Adherence Support Evaluation (CASE) index > 10 points was defined as optimal ART adherence, which was measured via participants' self-reported adherence during follow-up survey. Multivariable logistic regression was used to identify factors associated with ART adherence. Exploratory factor analysis (EFA) and multi-order latent variable structural equation modeling (SEM) were performed to explore the syndemic effect of multiple psychosocial factors on ART adherence.
A total of 734 (68.53%) follow-up participants were finally included in this study among the 1071 baseline participants, of whom 91.28% (670/734) had self-reported optimal ART adherence. Unemployment (aOR = 1.75, 95%CI: 1.01-3.02), no medication reminder (aOR = 2.28, 95%CI: 1.09-4.74), low medication self-efficacy (aOR = 2.28, 95%CI: 1.27-4.10), low social cohesion (aOR = 1.82, 95%CI: 1.03-3.19), no social participation (aOR = 5.65, 95%CI: 1.71-18.63), and ART side effects (aOR = 0.46, 95%CI: 0.26-0.81) were barriers to optimal ART adherence. The EFA and second-order latent variable SEM showed a linear relationship (standardized coefficient = 0.43, P < 0.001) between ART adherence and the latent psychosocial (syndemic) factor, which consisted of the three latent factors of medication beliefs and self-efficacy (standardized coefficient = 0.65, P < 0.001), supportive environment (standardized coefficient = 0.50, P < 0.001), and negative emotions (standardized coefficient=-0.38, P < 0.01). The latent factors of medication beliefs and self-efficacy, supportive environment, and negative emotions explained 42.3%, 25.3%, and 14.1% of the variance in the latent psychosocial factor, respectively.
About nine out of ten PLHIV on ART in Guangdong Province self-reported optimal ART adherence. However, more efforts should be made to address barriers to optimal ART adherence.
了解与抗逆转录病毒治疗（ART）依从性相关的因素对于“检测即治疗”时代 HIV 感染者（PLHIV）的 ART 成功至关重要。多种心理社会因素往往共存，并对 ART 依从性产生综合征效应。我们旨在探索与 PLHIV 新开始 ART 相关的因素，以及广东省新开始 ART 的 PLHIV 中多种心理社会因素对 ART 依从性的综合征效应。
2018 年 5 月至 2019 年 6 月期间，从广东省六个城市招募新诊断的 PLHIV，并从 2019 年 5 月开始对其进行随访至 2020 年 8 月。基线和随访数据通过问卷和国家 HIV 监测系统收集，本研究分析了随访数据。采用参与者在随访调查中自我报告的依从性来定义 CASE 指数>10 分作为最佳 ART 依从性。采用多变量逻辑回归来识别与 ART 依从性相关的因素。采用探索性因子分析（EFA）和多阶潜在变量结构方程模型（SEM）来探索多种心理社会因素对 ART 依从性的综合征效应。
在基线的 1071 名参与者中，最终有 734 名（68.53%）参加了随访，其中 91.28%（670/734）自我报告了最佳 ART 依从性。失业（OR=1.75，95%CI：1.01-3.02）、无药物提醒（OR=2.28，95%CI：1.09-4.74）、药物自我效能感低（OR=2.28，95%CI：1.27-4.10）、社会凝聚力低（OR=1.82，95%CI：1.03-3.19）、无社会参与（OR=5.65，95%CI：1.71-18.63）和 ART 副作用（OR=0.46，95%CI：0.26-0.81）是影响最佳 ART 依从性的障碍。EFA 和二阶潜在变量 SEM 显示，ART 依从性与潜在的心理社会（综合征）因素之间存在线性关系（标准化系数=0.43，P<0.001），该潜在的心理社会因素由药物信念和自我效能的三个潜在因素（标准化系数=0.65，P<0.001）、支持环境（标准化系数=0.50，P<0.001）和负性情绪（标准化系数=-0.38，P<0.01）组成。药物信念和自我效能、支持环境和负性情绪的潜在因素分别解释了潜在心理社会因素的 42.3%、25.3%和 14.1%的方差。
广东省约十分之九的新开始 ART 的 PLHIV 自我报告了最佳的 ART 依从性。然而，仍需要努力解决最佳 ART 依从性的障碍。
