Adherence, drug use, and treatment failure in a methadone-clinic-based program of directly administered antiretroviral therapy
Adherence, drug use, and treatment failure in a methadone-clinic-based program of directly administered antiretroviral therapy
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DOI：
10.1089/apc.2006.0192
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发表时间：
2007-08-01
影响因子：
4.9
通讯作者：
Moore, Richard D.
中科院分区：
文献类型：
--
作者：
Lucas, Gregory M.;Mullen, B. Anna;Moore, Richard D.
监督用药是结核病治疗的基石。使用直接抗逆转录病毒疗法（DAART）的艾滋病毒治疗策略越来越受到评估。在一项前瞻性单臂临床试验中，我们招募了接受美沙酮维持治疗的HIV感染者，在接受美沙酮治疗的当天接受监督剂量的抗逆转录病毒治疗（ART）。其他抗逆转录病毒治疗剂量均为自我给药。在这项分析中，我们检查了与DAART保留、遵守监督剂量和病毒学失败相关的因素。采用Kaplan-Meier方法和考克斯比例风险模型评估了DAART保留相关因素。通过逻辑回归和纵向数据分析技术评估与监督给药不依从和病毒学失败相关的因素。在9.4个月的中位随访期间，88名参与者共接受了16，453次监督剂量。受试者对监督给药的依从性中位数为83%。通过尿液药物筛查确定的活性药物使用与干预退出和不依从监督剂量的风险增加两倍相关。坚持监督剂量与病毒学失败密切相关。由于DAART仅在美沙酮给药日进行，因此在大多数参与者中，不到一半的总ART剂量被安排进行监督。计划监督的剂量百分比与依从性或病毒学失败无关。鉴于在许多患者中，监督的ART总剂量比例相对较小，未来的研究应评估DAART如何影响非监督剂量的依从性和ART的保留。
Supervised dosing is a cornerstone of tuberculosis treatment. HIV treatment strategies that use directly administered antiretroviral therapy (DAART) are increasingly being assessed. In a prospective single-arm clinical trial, we enrolled methadone-maintained, HIV-infected participants to receive supervised doses of antiretroviral therapy ( ART) on days when they received methadone. Other ART doses were self-administered. In this analysis we examined factors associated with retention to DAART, adherence to supervised doses, and virologic failure. Factors associated with retention to DAART were assessed with the Kaplan-Meier method and Cox proportional hazards models. Factors associated with nonadherence with supervised dosing and with virologic failure were assessed by logistic regression and techniques for longitudinal data analysis. A total of 16,453 supervised doses were administered to 88 participants over a median follow-up of 9.4 months. The median participant adherence with supervised dosing was 83%. Active drug use, determined by urine drug screens, was associated twofold increased risks of both intervention dropout and nonadherence with supervised doses. Adherence with supervised doses was strongly associated with virologic failure. Because DAART was administered only on methadone dosing days, fewer than half of the total ART doses were scheduled to be supervised in most participants. The percent of doses that was scheduled to be supervised was not associated with either adherence or with virologic failure. Given that a relatively small proportion of the total ART doses were supervised in many patients, future studies should assess how DAART affects adherence with non-supervised doses and retention to ART.