Faculty of Social Sciences, Centre for Population, Family and Health, University of Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium.
Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
AIDS Behav. 2024 Nov;28(11):3733-3747. doi: 10.1007/s10461-024-04447-3. Epub 2024 Aug 1.
Antiretroviral therapy (ART) adherence is crucial for health outcomes of people living with HIV (PLHIV), influenced by a complex interplay of individual, community, and household factors. This article focuses on the influence of household factors, as well as individual and community factors, on ART adherence among PLHIV in Cape Town who have recently initiated ART. Baseline data for a cluster-randomized controlled trial were collected from 316 PLHIV in 12 districts in Cape Town between 6th May 2021 and 22nd May 2022. Zero-inflated Poisson models, with cluster-adjusted standard errors, were used to analyse the association between individual, household, and community factors and ART adherence measures. At the household-level, household support was associated with both better self-rated adherence (exp(β) = 0.81, z = - 4.68, p < 0.001) and fewer days when pills were missed (exp(β) = 0.65, z = - 2.92, p = 0.003). Psychological violence (exp(β) = 1.37, z = 1.97, p = 0.05) and higher household asset scores (exp(β) = 1.29, z = - 2.83, p = 0.05) were weakly associated with poorer ART adherence. At the individual-level, male gender (exp(β) = 1.37, z = 3.95, p < 0.001) and reinitiating ART (exp(β) = 1.35, z = 3.64, p < 0.001) were associated with worse self-rated ART adherence; higher education levels (exp(β) = 0.30 times, z = - 3.75, p < 0.001) and better HIV knowledge (exp(β) = 0.28, z = - 2.83, p = 0.005) were associated with fewer days where pills were missed. At the community-level, community stigma was associated with worse self-rated ART adherence (exp(β) = 1.24, z = 3.01, p = 0.003). When designing interventions to improve ART adherence, household, individual and community factors should all be considered, particularly in addressing gender-based disparities, reducing stigma, tackling violence, and enhancing household support.Clinical Trial Number: Pan African Clinical Trial Registry, PACTR201906476052236. Registered on 24 June 2019.
抗逆转录病毒疗法 (ART) 依从性对于 HIV 感染者 (PLHIV) 的健康结果至关重要，这受到个体、社区和家庭因素复杂相互作用的影响。本文重点关注家庭因素以及个体和社区因素对开普敦新接受 ART 的 PLHIV 的 ART 依从性的影响。2021 年 5 月 6 日至 2022 年 5 月 22 日，在开普敦的 12 个区，从 316 名 PLHIV 中收集了一项整群随机对照试验的基线数据。使用零膨胀泊松模型，采用集群调整的标准误差，分析个体、家庭和社区因素与 ART 依从性测量之间的关联。在家庭层面，家庭支持与自我评估的依从性更好（exp(β)=0.81，z=-4.68，p<0.001）和错过服药天数更少（exp(β)=0.65，z=-2.92，p=0.003）相关。心理暴力（exp(β)=1.37，z=1.97，p=0.05）和更高的家庭资产评分（exp(β)=1.29，z=-2.83，p=0.05）与较差的 ART 依从性呈弱相关。在个体层面，男性（exp(β)=1.37，z=3.95，p<0.001）和重新开始 ART（exp(β)=1.35，z=3.64，p<0.001）与自我评估的 ART 依从性较差相关；更高的教育水平（exp(β)=0.30 倍，z=-3.75，p<0.001）和更好的 HIV 知识（exp(β)=0.28，z=-2.83，p=0.005）与错过服药天数较少相关。在社区层面，社区污名与自我评估的 ART 依从性较差有关（exp(β)=1.24，z=3.01，p=0.003）。在设计提高 ART 依从性的干预措施时，应考虑家庭、个人和社区因素，特别是在解决基于性别的差异、减少污名、解决暴力和增强家庭支持方面。临床试验编号：泛非临床试验注册处，PACT201906476052236。于 2019 年 6 月 24 日注册。
