Examining adherence barriers among women with HIV to tailor outreach for long-acting injectable antiretroviral therapy
Examining adherence barriers among women with HIV to tailor outreach for long-acting injectable antiretroviral therapy
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DOI：
10.1186/s12905-020-01011-8
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发表时间：
2020-07-25
影响因子：
2.5
通讯作者：
Murray, Miranda
中科院分区：
文献类型：
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作者：
Benning, Lorie;Mantsios, Andrea;Murray, Miranda
背景 在 3 期试验中，已发现长效 (LA) 注射抗逆转录病毒疗法 (ART) 不劣于每日口服 ART。 LA ART 可以解决口服 ART 依从性的主要障碍，并且对于一些 HIV 感染者来说比每日服用药物更可取。迄今为止，在 LA ART 研究中，女性的比例低于男性。利用美国妇女机构间艾滋病毒研究 (WIHS) 女性艾滋病毒感染者队列的纵向数据，我们研究了日常口服 ART 依从性可能与 LA ART 相关或通过 LA ART 解决的障碍和促进因素。方法 我们对 1998 年至 2017 年 WIHS 队列数据进行了二次分析，调查对象为自 1998 年以来至少就诊 4 次、报告至少使用过一次 ART 的参与者 (n = 2601)。使用广义线性模型拟合两个二分结果，即患者报告的每日口服 ART 依从性和病毒抑制，检查社会人口统计和结构因素的作用。结果 研究入组时，中位年龄为 40.5 岁，63% 的参与者是非裔美国人，22% 是拉丁裔。大多数人 (82%) 报告称，接受 ART 的时间超过 75%，其中 53% 的病毒得到抑制。在多变量分析中，几个女性亚组报告的依从性和病毒抑制的几率较低：1）年轻女性（依从性 aOR：0.71；病毒抑制 aOR：0.63）； 2) 注射毒品的女性（依从性 aOR：0.38；病毒抑制 aOR：0.50）以及中度（依从性 aOR：0.59；病毒抑制 aOR：0.74）和大量饮酒（依从性 aOR：0.51；病毒抑制 aOR：0.69）的女性； 3）有抑郁症状的人（依从性aOR：0.61；病毒抑制aOR：0.76）； 4) 有持续或停止 ART 病史（依从性 aOR：0.62，病毒抑制 aOR：0.38）或改变治疗方案（依从性 aOR：0.83，病毒抑制 aOR：0.56）的患者。结论 当前注射避孕药使用者（与非使用者相比）有更大的口服 ART 依从性（aOR：1.87）和病毒抑制（aOR：1.28）的可能性。调查结果确定了可能受益于 LA ART 并对 LA ART 感兴趣的女性概况。有必要开展进一步的研究，重点关注 LA ART 对于这些急需创新方法来实现持续病毒抑制的关键女性亚群的吸收和效用。
Background Long-acting (LA) injectable antiretroviral therapy (ART) has been found non-inferior to daily oral ART in Phase 3 trials. LA ART may address key barriers to oral ART adherence and be preferable to daily pills for some people living with HIV. To date, women have been less represented than men in LA ART research. Using longitudinal data from the Women's Interagency HIV Study (WIHS) cohort of women living with HIV in the United States, we examined barriers and facilitators of daily oral ART adherence that may be related to or addressed by LA ART. Methods We conducted a secondary analysis of WIHS cohort data from 1998 to 2017 among participants seen for at least 4 visits since 1998 who reported using ART at least once (n = 2601). Two dichotomous outcomes, patient-reported daily oral ART adherence and viral suppression were fit using generalized linear models, examining the role of socio-demographic and structural factors. Results At study enrollment, the median age was 40.5 years, 63% of participants were African American and 22% were Latina. The majority (82%) reported taking ART more than 75% of the time and 53% were virally suppressed. In multivariate analysis, several sub-groups of women had lower odds of reported adherence and viral suppression: 1) younger women (adherence aOR: 0.71; viral suppression aOR: 0.63); 2) women who inject drugs (adherence aOR: 0.38; viral suppression aOR: 0.50) and those with moderate (adherence aOR: 0.59; viral suppression aOR: 0.74) and heavy alcohol consumption (adherence aOR: 0.51; viral suppression aOR: 0.69); 3) those with depressive symptoms (adherence aOR: 0.61; viral suppression aOR: 0.76); and 4) those with a history of going on and off ART (adherence aOR: 0.62, viral suppression aOR: 0.38) or changing regimens (adherence aOR: 0.83, viral suppression aOR: 0.56). Conclusions Current injectable contraceptive users (vs. non-users) had greater odds of oral ART adherence (aOR: 1.87) and viral suppression (aOR: 1.28). Findings identify profiles of women who may benefit from and be interested in LA ART. Further research is warranted focused on the uptake and utility of LA ART for such key subpopulations of women at high need for innovative approaches to achieve sustained viral suppression.