Persisting with prevention: the importance of adherence for HIV prevention.
Persisting with prevention: the importance of adherence for HIV prevention.
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DOI：
10.1186/1742-7622-5-8
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发表时间：
2008-07-11
影响因子：
2.3
通讯作者：
Abu-Raddad, Laith J
中科院分区：
文献类型：
--
作者：
Weiss, Helen A;Wasserheit, Judith N;Barnabas, Ruanne V;Hayes, Richard J;Abu-Raddad, Laith J
在31个已完成的艾滋病毒预防策略的随机对照试验(RCT)中，只有4个显示出显著效果。依从性差可能是导致其中一些试验缺乏效果的原因之一。在这篇文章中，我们探讨了不同水平的依从性对随机对照试验中测量的疗效的影响。我们使用简单的定量方法来说明不同水平的坚持对测量的效果的影响，假设性行为方面的统一人口，以及每个伴侣的传播概率的二项式模型。在100%依从性的情况下，一次随机对照试验中测得的效力是真实生物效力的合理近似值。然而，随着依从性水平的下降，在试验中测量的疗效大大低估了真正的生物疗效。例如，在60%的依从性下，测量的效果可能不到真实生物效果的一半。试验期间依从性差会大大降低检测效果的能力，需要改进在试验中实现和保持高依从性的方法。目前有12项正在进行的艾滋病毒预防试验，除了一项试验外，所有试验都需要使用者持续遵守。在试验和设计随机对照试验和艾滋病毒预防方案时，必须注意最大限度地遵守的方法。
Only four out of 31 completed randomized controlled trials (RCTs) of HIV prevention strategies against sexual transmission have shown significant efficacy. Poor adherence may have contributed to the lack of effect in some of these trials. In this paper we explore the impact of various levels of adherence on measured efficacy within an RCT. We used simple quantitative methods to illustrate the impact of various levels of adherence on measured efficacy by assuming a uniform population in terms of sexual behavior and the binomial model for the transmission probability per partnership. At 100% adherence the measured efficacy within an RCT is a reasonable approximation of the true biological efficacy. However, as adherence levels fall, the efficacy measured within a trial substantially under-estimates the true biological efficacy. For example, at 60% adherence, the measured efficacy can be less than half of the true biological efficacy. Poor adherence during a trial can substantially reduce the power to detect an effect, and improved methods of achieving and maintaining high adherence within trials are needed. There are currently 12 ongoing HIV prevention trials, all but one of which require ongoing user-adherence. Attention must be given to methods of maximizing adherence when piloting and designing RCTs and HIV prevention programmes.