A review of HIV antiretroviral adherence and intervention studies among HIV-infected youth.
A review of HIV antiretroviral adherence and intervention studies among HIV-infected youth.
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发表时间：
2009-02
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通讯作者：
S. Reisner;M. Mimiaga;M. Skeer;Brandon Perkovich;Carey V. Johnson;S. Safren
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作者：
S. Reisner;M. Mimiaga;M. Skeer;Brandon Perkovich;Carey V. Johnson;S. Safren
抗逆转录病毒药物的进步导致艾滋病毒相关发病率和死亡率急剧下降；然而，高水平的依从性对于艾滋病毒治疗的成功至关重要。本文回顾了美国已发表的关于感染艾滋病毒的青少年（13 至 24 岁）的研究，重点关注抗逆转录病毒治疗方案的依从性和旨在提高依从性的干预措施。系统检索发现 1999 年至 2008 年间发表的 21 篇文章报告了感染艾滋病毒的青少年的药物依从性数据，其中 7 篇描述了提高药物依从性的独特干预措施。确定了五个主题领域来对与依从性相关的因素进行分类。研究结果表明，心理社会因素，特别是抑郁和焦虑，在各项研究中始终与较差的依从性相关。发现了三种针对感染艾滋病毒的青少年的依从性干预措施。结果表明，检查青少年生活中存在的更广泛背景问题的依从性，包括艾滋病毒耻辱和披露、照顾者压力、同伴关系、心理健康和药物使用以及服药时间长短，对于了解如何最好地干预该人群的依从性可能是最重要的。针对青少年的艾滋病毒二级预防干预措施代表了一种可能的模式，通过该模式可以提供个性化的依从性技能培养和咨询，以提高药物依从性。
Advances in antiretroviral medications have resulted in precipitous declines in HIV-associated morbidity and mortality; however, high levels of adherence are crucial to the success of HIV therapies. This article reviews published studies in the United States on HIV-infected youth (ages 13 to 24 years), focusing on adherence to antiretroviral regimens and interventions designed to enhance adherence. A systematic search yielded 21 articles published between 1999 and 2008 that reported data on medication adherence in HIV-infected youth, of which 7 described unique interventions to enhance medication adherence. Five thematic areas were identified to classify factors associated with adherence. Findings suggest psychosocial factors, in particular depression and anxiety, were consistently associated with poorer adherence across studies. Three types of adherence interventions with HIV-infected youth were found. Results suggest that examining adherence within the broader contextual issues present in the lives of youth, including HIV stigma and disclosure, caregiver stress, peer relations, mental health and substance use, and length of time on medications, may be most important to understanding how best to intervene with adherence among this population. Secondary HIV prevention interventions for youth represent a possible mode through which to deliver individually tailored adherence skill building and counseling to improve medication adherence.