Theory-guided, empirically supported avenues for intervention on HIV medication nonadherence: Findings from the healthy living project
Theory-guided, empirically supported avenues for intervention on HIV medication nonadherence: Findings from the healthy living project
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DOI：
10.1089/108729103771928708
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发表时间：
2003-12-01
影响因子：
4.9
通讯作者：
Chesney, MA
中科院分区：
文献类型：
--
作者：
Johnson, MO;Catz, SL;Chesney, MA
目标：坚持抗逆转录病毒治疗（ART）仍然是最大限度地提高艾滋病毒治疗效益的挑战。先前关于抗逆转录病毒治疗依从性的研究受到低统计功效、同质样本和有偏见的评估方法的限制。基于社会行动理论并使用大量不同的男性和女性艾滋病毒感染者样本，本研究的目标是阐明不遵守 ART 的相关性，并为干预不遵守 ART 提供理论指导、经验支持的方向。设计：利用计算机访谈进行横断面访谈研究。背景：从 2000 年 6 月至 1 月从美国四个城市的诊所、机构和通过媒体广告招募的人员2002.参与者：2765 名接受 ART 的 HIV 阳性成年人。主要结果指标：计算机评估的自我报告的抗逆转录病毒治疗依从性。结果：32% 的人报告在前 3 天内对 ART 的依从性低于 90%。在单变量分析中，许多因素与不依从性有关。多变量分析发现，作为非裔美国人、处于主要关系以及过去一年有注射吸毒或无家可归的历史与不遵守规定的可能性更大有关。此外，依从性自我效能、能够管理副作用以及将药物纳入日常生活中可以防止不依从性。厌倦服药与较差的依从性相关，而认为不依从会使病毒更强的信念与更好的依从性相关。结论：结果支持需要采取多重点干预措施来提高药物依从性，以解决后勤障碍、物质使用、态度和期望，以及技能建设和自我效能增强。有必要进一步探讨与非裔美国人和男性在主要关系中的依从性相关的问题。
Objectives: Adherence to antiretroviral therapy (ART) remains a challenge in efforts to maximize HIV treatment benefits. Previous studies of antiretroviral adherence are limited by low statistical power, homogeneous samples, and biased assessment methods. Based on Social Action Theory and using a large, diverse sample of men and women living with HIV, the objectives of the current study are to clarify correlates of nonadherence to ART and to provide theory-guided, empirically supported direction for intervening on ART nonadherence.Design: Cross-sectional interview study utilizing a computerized interview.Setting: Recruited from clinics, agencies, and via media ads in four U. S. cities from June 2000 to January 2002.Participants: Two thousand seven hundred and sixty-five HIV-positive adults taking ART.Main Outcome Measure: Computer-assessed self-reported antiretroviral adherence.Results: Thirty-two percent reported less than 90% adherence to ART in the prior 3 days. A number of factors were related to nonadherence in univariate analysis. Multivariate analyses identified that being African American, being in a primary relationship, and a history of injection drug use or homelessness in the past year were associated with greater likelihood of nonadherence. Furthermore, adherence self-efficacy, and being able to manage side effects and fit medications into daily routines were protective against nonadherence. Being tired of taking medications was associated with poorer adherence whereas a belief that nonadherence can make the virus stronger was associated with better adherence.Conclusions: Results support the need for multifocused interventions to improve medication adherence that address logistical barriers, substance use, attitudes and expectancies, as well as skills building and self-efficacy enhancement. Further exploration of issues related to adherence for African Americans and men in primary relationships is warranted.