Intentional Medication Nonadherence Because of Interactive Toxicity Beliefs Among HIV-Positive Active Drug Users.
Intentional Medication Nonadherence Because of Interactive Toxicity Beliefs Among HIV-Positive Active Drug Users.
复制标题
DOI：
10.1097/qai.0000000000000776
复制
发表时间：
2015-12-15
期刊：
影响因子：
--
通讯作者：
Merely C
中科院分区：
文献类型：
--
作者：
Kalichman SC;Kalichman MO;Cherry C;Hoyt G;Washington C;Grebler T;Welles B;Merely C
吸毒对艾滋病毒感染的医疗管理提出了重大挑战。虽然大多数研究都集中在中毒对无意坚持艾滋病毒治疗的影响，但吸毒也可能导致故意不坚持治疗，特别是当个人认为药物与药物混合是有害的时。本研究探讨了在前瞻性的依从性监测期间，交互毒性信念是否可以预测不依从抗逆转录病毒治疗（ART）。吸毒筛查呈阳性并正在接受 ART 治疗的艾滋病毒感染者 (N=530) 完成了计算机化的自我访谈、三个前瞻性未公布的药物计数以衡量 ART 依从性、提供了用于药物筛查的尿液样本以及医疗记录中的 HIV 病毒载量结果。结果显示，189 名 (35%) 参与者表示，他们在吸毒时故意错过了 ART。这些参与者还报告了关于将艾滋病毒药物与酒精和其他药物混合的已知危害的共同看法。控制人口和健康特征以及饮酒频率的多变量模型表明，故意不坚持治疗预示着未来一个月内 ART 依从性较差，并且还预测了以未抑制的 HIV 病毒载量为指标的治疗结果较差。这些发现扩展了之前的研究，表明交互毒性信念和故意不依从性在大量艾滋病毒感染者不依从用药方面发挥着重要作用，应在艾滋病毒临床护理中积极解决。
Drug use poses significant challenges to medical management of HIV infection. While most research has focused on the influence of intoxication on unintentional adherence to HIV treatment, drug use may also lead to intentional non-adherence, particularly when individuals believe that mixing medications with drugs is harmful. This study examined whether interactive toxicity beliefs predict non-adherence to antiretroviral therapy (ART) over a prospective period of adherence monitoring. Men and women living with HIV who screened positive for drug use and were being treated with ART (N=530) completed computerized self-interviews, three prospective unannounced pill counts to measure ART adherence, provided urine specimens for drug screening, and HIV viral load results from medical records. Results showed that 189 (35%) participants indicated that they intentionally miss their ART when they are using drugs. These participants also reported common beliefs regarding the perceived hazards of mixing HIV medications with alcohol and other drugs. Multivariable models that controlled for demographic and health characteristics, as well as frequency of alcohol use, showed that intentional non-adherence predicted poorer ART adherence over the prospective month and also predicted poorer treatment outcomes as indexed by unsuppressed HIV viral load. These findings extend previous research to show that interactive toxicity beliefs and intentional non-adherence play a significant role in medication non-adherence for a substantial number of people living with HIV and should be actively addressed in HIV clinical care.