Predictors and Profiles of Antiretroviral Therapy Adherence Among African American Adolescents and Young Adult Males Living with HIV
Predictors and Profiles of Antiretroviral Therapy Adherence Among African American Adolescents and Young Adult Males Living with HIV
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DOI：
10.1089/apc.2015.0351
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发表时间：
2016-07-01
影响因子：
4.9
通讯作者：
Fernandez, M. Isabel
中科院分区：
文献类型：
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作者：
Gross, Israel Moses;Hosek, Sybil;Fernandez, M. Isabel
坚持抗逆转录病毒治疗（ART）对于阻止艾滋病毒疾病进展和减少继发性艾滋病毒传播至关重要，但青年艾滋病毒感染者（YLH）难以坚持治疗。在美国，新感染艾滋病毒的最高比率发生在年轻的非洲裔美国人中。从2010年至2012年在艾滋病毒/艾滋病干预青少年试验网络（ATN）内接受医疗护理的（YLH）横断面评估中选择了387名接受ART的艾滋病毒阳性年轻非洲裔美国男性样本（12-24岁，中位数22.00，SD 2.08）。参与者完成了自我报告的依从性，人口统计学，健康和心理社会措施。62%的人自我报告100%坚持抗逆转录病毒治疗。最佳数据分析将过去3个月内大麻使用频率确定为依从性最强的独立预测因子，产生中等效应强度敏感性（ESS）= 27.1，p < 0.001。在不经常使用大麻的参与者中，72%的人报告完全遵守;相比之下，只有45%的经常使用大麻的参与者报告完全遵守。分类树分析（CTA）被用来提高分类准确性，并确定ART依从性和不依从性的途径。CTA模型证明，将参与者正确分类为ART依从性或非依从性的概率提高了38%。最有可能坚持的参与者是那些心理压力低和饮酒量少的人（82%的人坚持）。最不可能坚持的参与者是那些心理压力较大并每周使用大麻的人（69%的人不坚持）。研究结果表明，艾滋病毒感染的年轻非洲裔美国男性坚持抗逆转录病毒治疗的多个配置文件，并主张有针对性的心理干预。
Adherence to antiretroviral therapy (ART) is crucial for thwarting HIV disease progression and reducing secondary HIV transmission, yet youth living with HIV (YLH) struggle with adherence. The highest rates of new HIV infections in the United States occur in young African American men. A sample of 387 HIV-positive young African American males on ART was selected from a cross-sectional assessment of (YLH) receiving medical care within the Adolescent Trials Network for HIV/AIDS Interventions (ATN) from 2010 to 2012 (12-24 years old, median 22.00, SD 2.08). Participants completed self-reported adherence, demographic, health, and psychosocial measures. Sixty-two percent self-reported 100% ART adherence. Optimal data analysis identified frequency of cannabis use during the past 3 months as the strongest independent predictor of adherence, yielding moderate effect strength sensitivity (ESS) = 27.1, p < 0.001. Among participants with infrequent cannabis use, 72% reported full adherence; in contrast, only 45% of participants who used cannabis frequently reported full adherence. Classification tree analysis (CTA) was utilized to improve classification accuracy and to identify the pathways of ART adherence and nonadherence. The CTA model evidenced a 38% improvement above chance for correctly classifying participants as ART adherent or nonadherent. Participants most likely to be adherent were those with low psychological distress and minimal alcohol use (82% were adherent). Participants least likely to be adherent were those with higher psychological distress and engaged in weekly cannabis use (69% were nonadherent). Findings suggest multiple profiles of ART adherence for young African American males living with HIV and argue for targeted psychosocial interventions.