Adherence to antiretroviral therapy in a clinical cohort of HIV-infected children in East Africa.
Adherence to antiretroviral therapy in a clinical cohort of HIV-infected children in East Africa.
复制标题
DOI：
10.1371/journal.pone.0191848
复制
发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Wiehe SE
中科院分区：
文献类型：
--
作者：
Vreeman RC;Ayaya SO;Musick BS;Yiannoutsos CT;Cohen CR;Nash D;Wabwire D;Wools-Kaloustian K;Wiehe SE
描述东非国际艾滋病评估流行病学数据库(IeDEA)联合体的一个大型HIV感染儿童队列的抗逆转录病毒治疗(ART)依从性及其相关因素。这项研究使用了前瞻性收集的13岁以下HIV感染儿童的临床数据，他们在肯尼亚、乌干达和坦桑尼亚的4个临床护理计划(26个临床地点)内启动了抗逆转录病毒治疗，并进行了长达6年的跟踪调查。这些项目使用了3种依从性措施中的一种，包括7天定量回忆、7天绝对回忆和临床医生药物评估。我们采用分层的三水平Logistic回归模型来检查依从性，观察嵌套在患者中，患者在为该分析提供儿科HIV数据的26个地点内。在东非，3,304名儿童(52.0%为男性)参加了护理，并随后接受了中位数92周的观察(四分位数范围为50.3-145.0周)。开始接受ART治疗时的中位年龄为5.5岁([IQR]3.0-8.5岁)。根据每个诊所的测量结果，“良好”依从性非常高，在所有年份的随访中，平均保持在90%以上。接受抗逆转录病毒治疗的时间越长，依从性越高(在接受抗逆转录病毒治疗的每一周，调整后的优势比-AOR-每对数转换周：1.095，95%可信区间-CI-[1.052-1.150]。)参加大容量计划的患者表现出更高的临床医生评估依从率(每500名患者的AOR：1.174，95%CI[1.108-1.245])。在报告的依从性中观察到显著的部位水平变异性(0.28)，在患者中的变异性更高(0.71)。在子分析中，在ART开始时成为孤儿与较低的ART依从率密切相关(AOR：0.919，95%CI[0.864-0.976])。在HIV护理中，自我报告的依从性在1.8年的中位数上仍然很高，但根据患者水平和地点水平的因素而不同。建议使用经过验证的措施和对弱势群体的关注进行一致的遵从性监测。
To describe antiretroviral therapy (ART) adherence and associated factors for a large HIV-infected pediatric cohort followed by sites of the East Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) consortium. This study utilized prospectively collected clinical data from HIV-infected children less than 13 years of age who initiated ART within 4 clinical care programs (with 26 clinical sites) in Kenya, Uganda, and Tanzania and were followed for up to 6 years. Programs used one of 3 adherence measures, including 7-day quantitative recall, 7-day categorical recall, and clinician pill assessments. We fit a hierarchical, three-level, logistic-regression model to examine adherence, with observations nested within patient, and patients within the 26 sites providing pediatric HIV data to this analysis. In East Africa, 3,304 children, 52.0% male, were enrolled in care and were subsequently observed for a median of 92 weeks (inter-quartile range [IQR] 50.3–145.0 weeks). Median age at ART initiation was 5.5 years ([IQR] 3.0–8.5 years). “Good” adherence, as reported by each clinic’s measures, was extremely high, remaining on average above 90% throughout all years of follow-up. Longer time on ART was associated with higher adherence (adjusted Odds Ratio–aOR–per log-transformed week on ART: 1.095, 95% Confidence Interval–CI–[1.052–1.150].) Patients enrolled in higher-volume programs exhibited higher rates of clinician-assessed adherence (aOR per log-500 patients: 1.174, 95% CI [1.108–1.245]). Significant site-level variability in reported adherence was observed (0.28), with even higher variability among patients (0.71). In a sub-analysis, being an orphan at the start of ART was strongly associated with lower ART adherence rates (aOR: 0.919, 95% CI [0.864–0.976]). Self-reported adherence remained high over a median of 1.8 years in HIV care, but varied according to patient-level and site-level factors. Consistent adherence monitoring with validated measures and attention to vulnerable groups is recommended.
登录
查看更多内容
DOI：
10.1097/00042560-200205010-00014
发表时间：
2002-05-01
期刊：
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
影响因子：
--
作者：
de Olalla, PG;Knobel, H;Caylà, JA
通讯作者：
Caylà, JA
影响因子：
2.4
作者：
Biressaw S;Abegaz WE;Abebe M;Taye WA;Belay M
通讯作者：
Belay M
影响因子：
2.6
作者：
Eby, Jessica;Chapman, Jennifer;Lowenthal, Elizabeth
通讯作者：
Lowenthal, Elizabeth
影响因子：
3.8
作者：
Bangsberg, DR;Perry, S;Moss, A
通讯作者：
Moss, A
影响因子：
4.4
作者：
Bikaako-Kajura, Winnie;Luyirika, Emmanuel;Bunnell, Rebecca
通讯作者：
Bunnell, Rebecca