Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama.
National Research System, National Secretariat of Science, Technology and Innovation, Panama City, Panama.
PLoS One. 2024 Nov 27;19(11):e0311048. doi: 10.1371/journal.pone.0311048. eCollection 2024.
BACKGROUND: The prevalence of HIV in Panama is estimated to be 1.0%; only 71% of individuals on antiretroviral treatment (ART) were virally suppressed in 2022. This study aimed to describe the prevalence of suboptimal adherence (≥1 missed doses in previous four weeks) and limited retention in HIV care (≥1 missed HIV care appointments in previous 12 months) among adults (aged ≥18 years) who attended the most populous urban ART Clinic in Panama City. METHODS: In this cross-sectional study, participants completed a self-administered questionnaire. Univariable and bivariable analyses were used to describe the prevalence of suboptimal adherence and limited retention in HIV care. Multivariable logistic regression identified factors associated with suboptimal adherence at p<0.05. RESULTS: We included 375 participants (209 identified as men, 158 as women, 8 another gender). Of those who responded, 37.3% (n = 125/335) reported suboptimal adherence: 28.6% (n = 53/185) of men, 49.0% (n = 71/145) women, 20.0% (n = 1/5) another gender; p<0.01; 18.6% (n = 69/371) reported limited retention in care:13.6% (n = 28/206) men, 24.2% (n = 38/157) women, 37.5% (n = 3/8) another gender, p = 0.01. In multivariable analyses, suboptimal adherence was associated with gender (49.0%women vs. 28.6% men, AOR = 1.86, 95%CI:0.97-3.57), depressive symptoms:46.2% severe symptoms vs. 28.1% minimal-mild, AOR = 2.19,95%CI:0.96-5.04), and lifetime intimate partner emotional violence (IPV) 48.2% vs.no emotional IPV 32.2%, OR = 1.96,95%CI:1.15-2.90, and lifetime physical IPV 46.9% vs.no physical IPV 32.6%, OR = 1.82, 95%CI:1.15-2.90. In unadjusted analyses, limited retention in care was associated with gender (24.2%women vs.13.6% men OR = 2.03, 95%CI:1.18-3.49), difficulty paying rent/mortgage/utilities (22.6% vs.14.9% no difficulty paying, OR = 1.67,95%CI = 0.98-2.83); no variables were associated in the multivariable model. CONCLUSIONS: This study found high prevalence of suboptimal ART adherence and limited retention in care, especially among women; these factors were associated with severe depressive symptoms, as well as lifetime emotional and physical IPV. These results show the need for integrated mental health and IPV intervention for all individuals, including focused support for women.
背景：据估计，巴拿马的艾滋病毒感染率为 1.0%；2022 年，仅有 71%接受抗逆转录病毒治疗（ART）的个体病毒得到抑制。本研究旨在描述在巴拿马城人口最多的城市内 ART 诊所就诊的成年人（年龄≥18 岁）中，亚最佳依从性（过去四周内漏用≥1 剂）和有限的 HIV 护理保留率（过去 12 个月内漏用≥1 次 HIV 护理预约）的流行情况。
方法：在这项横断面研究中，参与者完成了一份自我管理的问卷。使用单变量和双变量分析来描述亚最佳依从性和有限的 HIV 护理保留率的流行情况。多变量逻辑回归分析确定了与亚最佳依从性相关的因素，p<0.05。
结果：我们纳入了 375 名参与者（209 名被确定为男性，158 名女性，8 名其他性别）。在做出回应的人中，37.3%（n=125/335）报告存在亚最佳依从性：28.6%（n=53/185）的男性，49.0%（n=71/145）的女性，20.0%（n=1/5）的其他性别；p<0.01；18.6%（n=69/371）报告有限的护理保留率：13.6%（n=28/206）的男性，24.2%（n=38/157）的女性，37.5%（n=3/8）的其他性别，p=0.01。在多变量分析中，亚最佳依从性与性别（49.0%女性与 28.6%男性，AOR=1.86，95%CI：0.97-3.57）、严重程度的抑郁症状（46.2%严重症状与 28.1%轻度症状，AOR=2.19，95%CI：0.96-5.04）和终生亲密伴侣情感暴力（IPV）（48.2%有过情感 IPV 与 32.2%没有过情感 IPV，OR=1.96，95%CI：1.15-2.90）和终生身体暴力 IPV（46.9%有过身体 IPV 与 32.6%没有过身体 IPV，OR=1.82，95%CI：1.15-2.90）有关。在未调整的分析中，有限的护理保留率与性别（24.2%女性与 13.6%男性，OR=2.03，95%CI：1.18-3.49）、支付租金/抵押贷款/水电费困难（22.6%与 14.9%没有支付困难，OR=1.67，95%CI=0.98-2.83）有关；多变量模型中没有变量与之相关。
结论：本研究发现，亚最佳 ART 依从性和有限的护理保留率的流行率很高，尤其是女性；这些因素与严重的抑郁症状以及终生的情感和身体 IPV 有关。这些结果表明，所有个体都需要进行心理健康和 IPV 综合干预，包括为女性提供重点支持。
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