High self-reported non-adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi: barriers and associated factors.
High self-reported non-adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi: barriers and associated factors.
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DOI：
10.7448/ias.20.1.21437
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发表时间：
2017-03-30
影响因子：
6
通讯作者：
Abrams EJ
中科院分区：
文献类型：
--
作者：
Kim MH;Mazenga AC;Yu X;Ahmed S;Paul ME;Kazembe PN;Abrams EJ
导言：在全球范围内，青少年和青壮年占新感染艾滋病毒人数的40%以上，从2005年到2012年，青少年中与艾滋病毒相关的死亡人数增加了50%。坚持抗逆转录病毒治疗对于控制病毒复制和保持健康至关重要；然而，在南部非洲越来越多的感染艾滋病毒/艾滋病的青少年中，缺乏对依从性的研究。我们检查了马拉维艾滋病患者自我报告的抗逆转录病毒治疗依从性水平、依从性障碍以及与不依从性相关的因素。方法：在马拉维中部和东南部的两个大型艾滋病诊所对519名ALHIV（12-18岁）进行横断面研究。参与者自我报告错过的剂量（过去一周/一个月），坚持治疗的障碍，并完成关于过去创伤事件/压力源，披露，抑郁，药物使用，治疗自我效能和社会支持的问卷调查。从现有的医疗记录中检索生物医学数据。进行多变量logistic回归以确定与自我报告的ART依从性（7天回忆）独立相关的因素。结果：参与者的平均年龄（SD）为14.5(2)岁，其中290（56%）为女性。在519名参与者中，153名（30%）报告在过去一周内未接受抗逆转录病毒治疗，234名（45%）报告在过去一个月内未接受抗逆转录病毒治疗。通常报告的坚持障碍包括忘记（39%）、离家旅行（14%）、忙于其他事情（11%）、感到沮丧/不堪重负（6%）、感到被外界（5%）和家中（3%）的人羞辱。与过去一周未给药独立相关的因素有：过去一个月饮酒（OR 4.96, 95% CI[1.41-17.4]）、过去6个月未见门诊预约（OR 2.23, 95% CI[1.43-3.49]）、目睹或经历过家庭暴力（OR 1.86, 95% CI[1.08-3.21]）和治疗自我效能差（OR 1.55 95% CI[1.02-2.34]）。性别和年龄与依从性无关。结论：在我们的研究中，近一半的艾滋病毒感染者报告在过去一个月没有坚持抗逆转录病毒治疗。在过去的一年中，家庭暴力或酒精使用以及治疗自我效能感差与较差的依从性有关。次优依从性是ALHIV的主要问题，并影响治疗结果。专门针对与艾滋病病毒最相关的挑战制定的规划可能有助于提高抗逆转录病毒治疗的依从性。
Introduction: Globally adolescents and young adults account for more than 40% of new HIV infections, and HIV-related deaths amongst adolescents increased by 50% from 2005 to 2012. Adherence to antiretroviral therapy (ART) is critical to control viral replication and preserve health; however, there is a paucity of research on adherence amongst the growing population of adolescents living with HIV/AIDS (ALHIV) in Southern Africa. We examined levels of self-reported ART adherence, barriers to adherence, and factors associated with non-adherence amongst ALHIV in Malawi. Methods: Cross-sectional study of 519 ALHIV (12–18 years) attending two large HIV clinics in central and south-eastern Malawi. Participants self-reported missed doses (past week/month), barriers to adherence, and completed questionnaires on past traumatic events/stressors, disclosure, depression, substance use, treatment self-efficacy, and social support. Biomedical data were retrieved from existing medical records. Multivariate logistic regression was performed to identify factors independently associated with self-reported ART adherence (7 day recall). Results: The mean age of participants (SD) was 14.5 (2) years and 290 (56%) were female. Of the 519 participants, 153 (30%) reported having missed ART doses within the past week, and 234 (45%) in the past month. Commonly reported barriers to adherence included forgetting (39%), travel from home (14%), busy with other things (11%), feeling depressed/overwhelmed (6%), feeling stigmatized by people outside (5%) and within the home (3%). Factors found to be independently associated with missing a dose in the past week were drinking alcohol in the past month (OR 4.96, 95% CI [1.41–17.4]), missed clinic appointment in the past 6 months (OR 2.23, 95% CI [1.43–3.49]), witnessed or experienced violence in the home (OR 1.86, 95% CI [1.08–3.21]), and poor treatment self-efficacy (OR 1.55 95% CI [1.02–2.34]). Sex and age were not associated with adherence. Conclusions: In our study, nearly half of all ALHIV reported non-adherence to ART in the past month. Violence in the home or alcohol use in the past year as well as poor treatment self-efficacy were associated with worse adherence. Sub-optimal adherence is a major issue for ALHIV and compromise treatment outcomes. Programmes specifically tailored to address those challenges most pertinent to ALHIV may help improve adherence to ART.