The role of material deprivations in determining ART adherence: Evidence from a conjoint analysis among HIV-positive adults in Uganda.
The role of material deprivations in determining ART adherence: Evidence from a conjoint analysis among HIV-positive adults in Uganda.
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DOI：
10.1371/journal.pgph.0000374
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发表时间：
2022
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尽管全球持续扩大抗逆转录病毒疗法，但坚持抗逆转录病毒疗法的人数仍然很少。在乌干达接受艾滋病毒护理的人中，只有不到一半的人能够达到85%的抗逆转录病毒药物依从性，这是临床上有意义的病毒抑制所必需的，使他们面临更高的传播风险。坚持抗逆转录病毒治疗的主要障碍包括与贫困相关的结构性障碍，这些障碍相互关联，同时发生，因此很难从经验上审查和理清这些障碍，进而设计有效的干预措施。许多艾滋病毒感染者（PLWH）在这些不同的障碍之间进行权衡（例如，为了能够估计与贫困相关的关键结构性障碍的明显影响，我们对2019年7月至2020年9月期间在乌干达一家城市诊所接受ART治疗的320名艾滋病毒阳性成年人进行了联合分析（CA）。我们改变了同时发生的四个与贫困相关的属性（食品安全，睡眠剥夺，月收入和身体疼痛）的水平，并询问受访者在不同属性水平组合下如何坚持服药。这使我们能够将每个属性的效果从另一个属性中分离出来，并评估它们的相对重要性。我们使用回归分析来估计每个属性水平的影响，发现食品安全对预期依从性的影响最大（治疗效果= 1.3; 95% CI 1.11-1.49，p<0.001），其次是收入（治疗效果= 0.99; 95% CI 0.88-1.10，p<0.001）。睡眠和疼痛也会影响依从性，尽管幅度较小。通过回归分析进行的分组分析检查结果的异质性，并表明，物质匮乏对预期遵守的影响在那些现有粮食不安全程度较高的人中更大。从这个CA的结果表明，穷人的生活中固有的外部因素和无关的直接获得抗逆转录病毒治疗可能是重要的障碍，坚持抗逆转录病毒治疗。这项研究适用于艾滋病毒携带者之间的CA（通常在营销应用管理），以更好地了解个人层面的看法，往往同时发生的贫困。政策干预措施应解决粮食不安全和收入问题，以提高艾滋病毒阳性成年人的依从性。
Despite sustained global scale-up of antiretroviral therapy (ART), adherence to ART remains low. Less than half of those in HIV care in Uganda achieve 85% adherence to their ART medication required for clinically meaningful viral suppression, leaving them at higher risk of transmission. Key barriers to ART adherence include poverty-related structural barriers that are inter-connected and occur simultaneously, making it challenging to examine and disentangle them empirically and in turn design effective interventions. Many people living with HIV (PLWH) make tradeoffs between these various barriers (e.g., between expenses for food or transportation) and these can influence long-term health behavior such as adherence to ART. To be able to estimate the distinct influence of key structural barriers related to poverty, we administered a conjoint analysis (CA) to 320 HIV-positive adults currently taking ART at an urban clinic in Uganda between July 2019 and September 2020. We varied the levels of four poverty-related attributes (food security, sleep deprivation, monthly income, and physical pain) that occur simultaneously and asked respondents how they would adhere to their medication under different combinations of attribute levels. This allows us to disentangle the effect of each attribute from one another and to assess their relative importance. We used regression analysis to estimate the effects of each attribute level and found that food security impacts expected adherence the most (treatment effect = 1.3; 95% CI 1.11–1.49, p<0.001), followed by income (treatment effect = 0.99; 95% CI 0.88–1.10, p<0.001. Sleep and pain also impact adherence, although by a smaller magnitude. Sub-group analyses conducted via regression analysis examine heterogeneity in results and suggest that the effects of material deprivations on expected adherence are greater among those with high levels of existing food insecurity. Results from this CA indicate that external factors inherent in the lives of the poor and unrelated to direct ART access can be important barriers to ART adherence. This study applies a CA (typically administered in marketing applications) among PLWH to better understand individual-level perceptions relating to poverty that often occur simultaneously. Policy interventions should address food insecurity and income to improve adherence among HIV-positive adults.