Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis.
Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis.
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DOI：
10.1186/preaccept-1453408941291432
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发表时间：
2014-08-21
期刊：
影响因子：
9.3
通讯作者：
Nieuwkerk PT
中科院分区：
文献类型：
--
作者：
Langebeek N;Gisolf EH;Reiss P;Vervoort SC;Hafsteinsdóttir TB;Richter C;Sprangers MA;Nieuwkerk PT
坚持抗逆转录病毒联合治疗（ART）是人类免疫缺陷病毒（HIV）治疗成功的关键预测因素，并且可能需要干预。深入了解不坚持抗逆转录病毒治疗的预测因素或相关因素，可能有助于指导制定坚持增强干预措施的目标。我们的目的是回顾有关抗逆转录病毒治疗依从性的预测因素/相关因素的证据，并将研究结果汇总成对依从性影响的定量估计。我们在PubMed检索了1996年至2014年6月之间发表的原始英语论文，以及找到的所有相关文章的参考文献列表。报告成人慢性HIV感染抗逆转录病毒治疗依从性的预测因素/相关因素的研究纳入，不受依从性评估方法、研究设计或地理位置的限制。两名研究人员分别从同一篇论文中提取了数据。随机效应模型采用反向方差权重，以95%置信区间将研究结果汇总为合并效应估计。采用标准化平均差（SMD）作为常见效应量。研究设计特征（依从性评估方法、研究设计和研究所在国的联合国人类发展指数（HDI））的影响采用分类混合效应元回归进行调查。总共纳入了207项研究。以下预测因素/相关因素与依从性的关系最为密切：依从性自我效能（SMD = 0.603, P = 0.001）、当前药物使用（SMD = -0.395, P = 0.001）、对ART的关注（SMD = -0.388, P = 0.001）、对ART必要性/效用的信念（SMD = 0.357, P = 0.001）、对HIV护理提供者的信任/满意度（SMD = 0.377, P = 0.001）、抑郁症状（SMD = -0.305, P = 0.001）、对HIV的污名（SMD = -0.282, P = 0.001）和社会支持（SMD = 0.237, P = 0.001）。在以下方面观察到较小但显著的关联：服用含有蛋白酶抑制剂的方案（SMD = -0.196, P = 0.001）、每日给药频率（SMD = -0.193, P = 0.001）、财务约束（SMD = -0.187, P = 0.001）和服药负担（SMD = -0.124, P = 0.001）。与高人类发展指数国家相比，低和中等人类发展指数国家对艾滋病毒护理提供者较高的信任/满意度、较低的每日给药频率和较少的抑郁症状与较高的依从性相关性更强。这些发现表明，增强依从性的干预措施应特别针对心理因素，如自我效能感和对抗逆转录病毒治疗的疗效和安全性的担忧/信念。此外，这些发现表明，简化治疗方案可能会产生较小但显著的影响。本文的在线版本（doi:10.1186/s12916-014-0142-1）包含补充材料，可供授权用户使用。
Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence. We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression. In total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, P = 0.001), current substance use (SMD = -0.395, P = 0.001), concerns about ART (SMD = -0.388, P = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, P = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, P = 0.001), depressive symptoms (SMD = -0.305, P = 0.001), stigma about HIV (SMD = -0.282, P = 0.001), and social support (SMD = 0.237, P = 0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD = -0.196, P = 0.001), daily dosing frequency (SMD = -0.193, P = 0.001), financial constraints (SMD -0.187, P = 0.001) and pill burden (SMD = -0.124, P = 0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries. These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects. The online version of this article (doi:10.1186/s12916-014-0142-1) contains supplementary material, which is available to authorized users.