Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana
Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana
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DOI：
10.1097/00126334-200311010-00004
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发表时间：
2003-11-01
影响因子：
3.6
通讯作者：
Marlink, R
中科院分区：
文献类型：
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作者：
Weiser, S;Wolfe, W;Marlink, R
背景：博茨瓦纳是世界上艾滋病毒感染率最高的国家，估计15-49岁人口中的感染率为36%。为了提高抗逆转录病毒（ARV）治疗的提供，我们进行了一项横断面研究的社会，文化和结构的决定因素的治疗adherence.Methods：我们使用了定性和定量的研究方法，包括问卷调查和访谈接受抗逆转录病毒治疗的患者和他们的医疗保健提供者，以引出坚持的主要障碍。患者报告和供应商估计的依从性（大于或等于95%剂量）的主要outcomes.Results：109例患者和60个医疗保健提供者之间进行了采访，2000年1月至7月，54%的患者是遵守自我报告，而56%的遵守供应商评估。观察到患者和供应商之间的协议为68%。依从性的主要障碍包括财务限制（44%），耻辱（15%），旅行/移民（10%）和副作用（9%）。Logistic回归分析表明，如果去除费用因素，抗逆转录病毒治疗依从性将从54%提高到74%。结论：本研究的抗逆转录病毒治疗依从性与发达国家相当。与其他地方一样，博茨瓦纳的卫生保健提供者往往无法确定哪些病人坚持接受抗逆转录病毒治疗。抗逆转录病毒治疗的费用是依从性的最大障碍。
Background: Botswana has the highest rate of HIV infection in the world, estimated at 36% among the population aged 15-49 years. To improve antiretroviral (ARV) treatment delivery, we conducted a cross-sectional study of the social, cultural, and structural determinants of treatment adherence.Methods: We used both qualitative and quantitative research methodologies, including questionnaires and interviews with patients receiving ARV treatment and their health care providers to elicit principal barriers to adherence. Patient report and provider estimate of adherence (greater than or equal to95% doses) were the primary outcomes.Results: One hundred nine patients and 60 health care providers were interviewed between January and July 2000; 54% of patients were adherent by self-report, while 56% were adherent by provider assessment. Observed agreement between patients and providers was 68%. Principal barriers to adherence included financial constraints (44%), stigma (15%), travel/migration (10%), and side effects (9%). On the basis of logistic regression, if cost were removed as a barrier, adherence is predicted to increase from 54% to 74%.Conclusions: ARV adherence rates in this study were comparable with those seen in developed countries. As elsewhere, health care providers in Botswana were often unable to identify which patients adhere to their ARV regimens. The cost of ARV therapy was the most significant barrier to adherence.