Multiple measures reveal antiretroviral adherence successes and challenges in HIV-infected Ugandan children.
Multiple measures reveal antiretroviral adherence successes and challenges in HIV-infected Ugandan children.
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DOI：
10.1371/journal.pone.0036737
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Bangsberg DR
中科院分区：
文献类型：
--
作者：
Haberer JE;Kiwanuka J;Nansera D;Ragland K;Mellins C;Bangsberg DR
对于发展中国家儿童对艾滋病毒抗逆转录病毒治疗 (ART) 的依从性知之甚少。为了了解 ART 依从行为的水平、分布和相关性，我们前瞻性地通过多种措施和 121 名 2-10 岁乌干达儿童每六个月的 HIV RNA 水平确定了每月 ART 依从性，为期一年。按三天回忆计算的中位依从性水平为 100%，按 30 天视觉模拟量表计算的中位依从性水平为 97.4%，按未公布的药片计数/液体配方重量计算的中位依从性水平为 97.3%，按药物事件监测器 (MEMS) 计算的中位依从性水平为 96.3%。 57.0% 的儿童出现 MEMS 依从中断≥48 小时； 36.3% 的人在一年内可检测到 HIV RNA。只有 MEMS 与 HIV RNA 水平显着相关（r = −0.25，p = 0.04）。多变量回归发现以下因素与 MEMS 依从性 <90% 相关：儿童住院（调整后比值比 [AOR] 3.0，95% 置信区间 [CI] 1.6–5.5；p = 0.001）、液体制剂的使用（AOR 1.4、95%CI 1.0–2.0；p = 0.04）以及护理人员的饮酒（AOR 3.1，95%CI 1.8–5.2；p<0.0001）。儿童使用复方新诺明（AOR 0.5，95%CI 0.4–0.9；p = 0.009），看护者使用 ART（AOR 0.6，95%CI 0.4–0.9；p = 0.03），看护者可能患有抑郁症（AOR 0.6，95%CI） 0.4–0.8；p = 0.001），并且护理人员对儿童的 HIV 状况感到羞耻（AOR 0.5，95%CI 0.3–0.6；p<0.0001）可以防止 MEMS 依从性<90%。药品制造商的变化（AOR 4.1，95%CI 1.5–11.5；p = 0.009）和护理人员的饮酒（AOR 5.5，95%CI 2.8–10.7；p<0.0001）与 MEMS ≥48 小时中断相关，而二线 ART（AOR 0.3，95%CI） 0.1–0.99；p = 0.049）和增加资产（AOR 0.7，95%CI 0.6–0.9；p = 0.0007）可以防止这些中断。依从性的成功取决于良好的用药习惯，包括护理人员的支持和有关药物变化的充分教育。照顾者报告的抑郁和羞耻可能反映了对不良结果的恐惧，成为孩子坚持的动力。需要进一步的研究来更好地理解和利用这些关键影响因素来促进依从性干预的发展。
Adherence to HIV antiretroviral therapy (ART) among children in developing settings is poorly understood. To understand the level, distribution, and correlates of ART adherence behavior, we prospectively determined monthly ART adherence through multiple measures and six-monthly HIV RNA levels among 121 Ugandan children aged 2–10 years for one year. Median adherence levels were 100% by three-day recall, 97.4% by 30-day visual analog scale, 97.3% by unannounced pill count/liquid formulation weights, and 96.3% by medication event monitors (MEMS). Interruptions in MEMS adherence of ≥48 hours were seen in 57.0% of children; 36.3% had detectable HIV RNA at one year. Only MEMS correlated significantly with HIV RNA levels (r = −0.25, p = 0.04). Multivariable regression found the following to be associated with <90% MEMS adherence: hospitalization of child (adjusted odds ratio [AOR] 3.0, 95% confidence interval [CI] 1.6–5.5; p = 0.001), liquid formulation use (AOR 1.4, 95%CI 1.0–2.0; p = 0.04), and caregiver’s alcohol use (AOR 3.1, 95%CI 1.8–5.2; p<0.0001). Child’s use of co-trimoxazole (AOR 0.5, 95%CI 0.4–0.9; p = 0.009), caregiver’s use of ART (AOR 0.6, 95%CI 0.4–0.9; p = 0.03), possible caregiver depression (AOR 0.6, 95%CI 0.4–0.8; p = 0.001), and caregiver feeling ashamed of child’s HIV status (AOR 0.5, 95%CI 0.3–0.6; p<0.0001) were protective against <90% MEMS adherence. Change in drug manufacturer (AOR 4.1, 95%CI 1.5–11.5; p = 0.009) and caregiver’s alcohol use (AOR 5.5, 95%CI 2.8–10.7; p<0.0001) were associated with ≥48-hour interruptions by MEMS, while second-line ART (AOR 0.3, 95%CI 0.1–0.99; p = 0.049) and increasing assets (AOR 0.7, 95%CI 0.6–0.9; p = 0.0007) were protective against these interruptions. Adherence success depends on a well-established medication taking routine, including caregiver support and adequate education on medication changes. Caregiver-reported depression and shame may reflect fear of poor outcomes, functioning as motivation for the child to adhere. Further research is needed to better understand and build on these key influential factors for adherence intervention development.
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