Gender differences in factors associated with adherence to antiretroviral therapy
Gender differences in factors associated with adherence to antiretroviral therapy
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DOI：
10.1111/j.1525-1497.2004.30445.x
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发表时间：
2004-11-01
影响因子：
5.7
通讯作者：
Arnsten, JH
中科院分区：
文献类型：
--
作者：
Berg, KM;Demas, PA;Arnsten, JH
目的：确定与抗逆转录病毒依从性相关的社会和行为因素的性别差异。设计：前瞻性队列研究。设置：美沙酮维持计划。参与者：113名hiv血清阳性的当前或以前的阿片类药物使用者。测量方法和主要结果：参与者在基线时接受了社会和行为特征的调查，并在每月的研究访问中接受了关于药物和酒精使用以及药物副作用的调查。电子监测器（MEMS）用于测量抗逆转录病毒依从性。女性的中位依从性比男性低27%（46%比73%；P < 0.05）。在性别分层的多变量模型中，与男性依从性较差相关的因素包括不属于艾滋病毒支持小组（P < 0.0001），快克/可卡因使用（P < 0.005）和药物副作用（P = 0.01）。在女性中，酒精使用（P = 0.005）、海洛因使用（P < 0.05）和显著的药物副作用（P < 0.005）与较差的依从性独立相关。在一个包括男性和女性的模型中，较差的依从性与缺乏长期住房（P < 0.005），不属于任何艾滋病毒支持团体（P < 0.005），快克或可卡因使用（P < 0.01）以及药物副作用（P < 0.005）相关。此外，较差的依从性与女性性别和酒精使用之间的相互作用有关（P小于或等于0.05）。结论：在这个目前和以前阿片类药物使用者的队列中，性别分层分析表明，不同的社会和行为因素与男性和女性的依从性有关。在男性和女性中，较差的依从性与缺乏长期住房、不属于艾滋病毒支持小组、快克/可卡因使用和药物副作用有关。仅在女性中，饮酒与较差的依从性有关。
OBJECTIVE: To identify gender differences in social and behavioral factors associated with antiretroviral adherence.DESIGN: Prospective cohort study.SETTING: Methadone maintenance program.PARTICIPANTS: One hundred thirteen HIV-seropositive current or former opioid users.MEASUREMENTS AND MAIN RESULTS: Participants were surveyed at baseline about social and behavioral characteristics and at monthly research visits about drug and alcohol use and medication side effects. Electronic monitors (MEMS) were used to measure antiretroviral adherence. Median adherence among women was 27% lower than among men (46% vs. 73%; P < .05). In gender-stratified multivariate models, factors associated with worse adherence in men included not belonging to an HIV support group (P < .0001), crack/cocaine use (P < .005), and medication side effects (P = .01). Among women, alcohol use (P = .005), heroin use (P < .05), and significant medication side effects (P < .005) were independently associated with worse adherence. In a model including both men and women, worse adherence was associated with lack of long-term housing (P < .005), not belonging to any HIV support groups (P < .0005), crack or cocaine use (P < .01), and medication side effects (P < .0005). In addition, worse adherence was associated with the interaction between female gender and alcohol use (P less than or equal to .05).CONCLUSIONS: In this cohort of current and former opioid users, gender-stratified analysis demonstrated that different social and behavioral factors are associated with adherence in men and women. Among both men and women, worse adherence was associated with lack of long-term housing, not belonging to an HIV support group, crack/cocaine use, and medication side effects. Among women only, alcohol use was associated with worse adherence.