The role of psychosocial and family factors in adherence to antiretroviral treatment in human immunodeficiency virus-infected children
The role of psychosocial and family factors in adherence to antiretroviral treatment in human immunodeficiency virus-infected children
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DOI：
10.1097/01.inf.0000143646.15240.ac
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发表时间：
2004-11-01
影响因子：
3.6
通讯作者：
Abrams, EJ
中科院分区：
文献类型：
--
作者：
Mellins, CA;Brackis-Cott, E;Abrams, EJ
背景：抗逆转录病毒治疗（ART）方案的毒性和复杂性给患者的生活带来了巨大的挑战。本研究调查了影响围产期人类免疫缺陷病毒 (HIV) 感染儿童接受 ART 治疗的儿童心理社会和照顾者/家庭因素。方法：75 名儿童（3-13 岁）接受了 ART 治疗，他们的主要照顾者是从 2 个城市儿科 HIV 项目招募的。从所有看护者和 48 名 7 岁儿童那里收集了一系列心理评估和自我报告依从性数据。结果：40% 的看护者和 56% 的儿童报告在过去一个月中漏服了药物。将看护者或儿童报告漏服剂量（不依从）的家庭与报告没有漏服剂量（依从）的家庭进行比较。在单变量分析中，不依从性与儿童年龄较大（P < 0.05）、亲子沟通较差（P < 0.017）、看护者压力较高（P < 0.002）、看护者生活质量较低（P < 0.003）和看护者认知功能较差（P = 0.033）显着相关，并且与（1）儿童药物责任增加相关（P < 0.033）。 0.07），（2）向儿童透露艾滋病毒（P < 0.07）和（3）儿童压力（P < 0.08）在控制年龄的逻辑回归中，照顾者/家庭因素与不依从关系最强，包括亲子沟通较差（P < 0.03），照顾者压力较高（P < 0.01），向他人透露较少（P < 0.05）和生活质量（P < 0.05） 0.01).结论：我们的数据表明，提高儿童对复杂抗逆转录病毒治疗方案的依从性需要解决发育、社会心理和家庭因素。
Background: The toxicity and complexity of antiretroviral therapy (ART) regimens are substantial challenges in the context of patients' lives. This study examines child psychosocial and caregiver/family factors influencing adherence to ART in perinatally human immunodeficiency virus (HIV)-infected children.Methods: Seventy-five children (ages 3-13 years) prescribed ART, and their primary caregivers were recruited from 2 urban pediatric HIV programs. A battery of psychologic assessments and self-report adherence data were collected from all caregivers and 48 children who were 7 years old.Results: Forty percent of caregivers and 56% of children reported missed doses of medication in the past month. Families in which the caregiver or child reported missed doses (nonadherent) were compared with families who reported no missed doses (adherent). In univariate analyses, nonadherence was significantly associated with older child age (P < 0.05), worse parent-child communication (P < 0.017), higher caregiver stress (P < 0.002), lower caregiver quality of life (P < 0.003) and worse caregiver cognitive functioning (P = 0.033), and of borderline significance in its association with increased (1) child responsibility for medications (P < 0.07), (2) HIV disclosure to the child (P < 0.07) and (3) child stress (P < 0.08) In logistic regressions controlling for age, caregiver/family factors were the most strongly associated with nonadherence, including worse parent-child communication (P < 0.03), higher caregiver stress (P < 0.01), less disclosure to others (P < 0.05) and quality of life (P < 0.01).Conclusions: Our data suggest that efforts to improve children's adherence to complex antiretroviral regimens requires addressing developmental, psychosocial and family factors.