Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators.
Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators.
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DOI：
10.1371/journal.pmed.0030438
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发表时间：
2006-11
期刊：
影响因子：
15.8
通讯作者：
Cooper C
中科院分区：
文献类型：
--
作者：
Mills EJ;Nachega JB;Bangsberg DR;Singh S;Rachlis B;Wu P;Wilson K;Buchan I;Gill CJ;Cooper C
对于那些能够获得药物的人来说，坚持高效抗逆转录病毒治疗 (HAART) 药物是治疗成功和死亡率的最佳预测因素。我们系统地回顾了文献，以确定患者报告的坚持抗逆转录病毒治疗的障碍和促进因素。我们研究了发达国家和发展中国家。我们检索了以下数据库：AMED（成立至2005年6月）、Campbell Collaboration（成立至2005年6月）、CinAhl（成立至2005年6月）、Cochrane Library（成立至2005年6月）、Embase（成立至2005年6月）、ERIC（成立至2005年6月）、MedLine（成立至2005年6月）和NHS EED（成立至 2005 年 6 月）。我们检索了在发达国家和发展中国家进行的研究，这些研究考察了解决依从性的障碍和促进因素。定性和定量研究都包括在内。我们独立地一式两份地提取了有关依从性的定性研究中报告的数据。然后，我们检查了所有针对定性研究中指出的障碍和促进因素的定量研究。为了将定性研究的结果置于可推广的背景下，我们对调查进行了荟萃分析，以确定问题总体普遍程度的最佳估计。我们纳入了 37 项定性研究和 47 项使用定量方法（调查）的研究。 72 项研究（35 项定性）在发达国家进行，其余 12 项研究（两项定性）在发展中国家进行。两种经济环境中报告的重要障碍包括害怕披露、伴随药物滥用、健忘、对治疗的怀疑、过于复杂的治疗方案、所需的药片数量、生活质量、工作和家庭责任下降、入睡和获得药物。发达国家患者报告的重要促进因素包括自我价值感、看到抗逆转录病毒药物的积极作用、接受其血清阳性、理解严格遵守的必要性、使用提醒工具以及采取简单的治疗方案。在检验这些发现的普遍性的 37 项独立荟萃分析中，我们发现存在很大的异质性。我们发现，在多种环境和国家中，遵守的重要障碍是一致的。迫切需要进行研究来确定发展中国家环境中患者依从性的重要因素。临床医生应利用这些信息与患者进行公开讨论，以促进患者的依从性并识别其自身人群中的障碍和促进因素。对定性和定量研究的分析发现，在多个环境和国家中，坚持艾滋病毒治疗始终存在障碍，从获得药物到复杂治疗方案的问题。世界卫生组织估计，2005 年，全世界约有 3800 万人感染艾滋病毒/艾滋病；艾滋病毒/艾滋病造成的死亡率非常高。抗逆转录病毒药物可有效控制疾病并延长寿命。然而，人们必须严格遵守药物治疗方案，以保持较低的艾滋病毒水平，防止其对药物产生耐药性，并阻止病情恶化。然而，许多人发现很难按照应有的方式服用抗逆转录病毒药物。研究已经提供了一些证据来说明这种情况的原因。这些研究采用两种不同的研究方法：“定性”方法，试图通过焦点小组、访谈或其他技术来了解人们的态度和行为；“定性”方法，即试图通过焦点小组、访谈或其他技术来了解人们的态度和行为。 “定量”方法是通过调查来了解人们的意见和经验，并设置问题让参与者回答，然后统计不同的回答。研究人员希望将已发表的研究（称为“系统评价”）中的所有可用证据汇总起来，了解哪些因素影响人们对抗逆转录病毒药物的依从性。他们想要进行系统审查，因为这被认为是评估所有可用证据的一种非常严格的方式（尽管对于使用这种方法来分析定性研究结果的价值存在相当多的争论）。研究小组使用一组定义的搜索查询来搜索生物医学文献数据库以及会议摘要和研究登记册。他们筛选了所有发现的科学论文；然后对那些报告影响抗逆转录病毒治疗依从性因素的原始研究结果进行了更详细的分析。确定了 84 项相关研究，其中 37 项使用“定性”方法（焦点小组、访谈、开放式提问），47 项使用“定量”方法（调查）。这些研究大部分是在发达国家进行的。然后，研究人员从原始研究中提取了影响依从性的因素，这些因素可能是“积极”因素（有助于坚持）或“消极”因素（使坚持更加困难）。他们将这些因素分为四个关键主题：“与患者相关”（例如，看到积极的结果、害怕披露、感到沮丧）； “对药物的信念”（例如，对药物效果、副作用的信念）； “日常安排”（例如，使用提醒工具、打乱日常安排）；和“人际关系”（例如，与医疗保健提供者的信任关系；社会隔离）。 发达国家和发展中国家都存在许多遵守障碍。有些因素是在发展中国家进行的研究所特有的，例如财政限制和前往接受治疗的问题。对信息披露的恐惧是许多研究中发现的一个重要障碍。研究人员综合了许多不同研究的结果，并确定了有助于或阻碍坚持抗逆转录病毒治疗的因素。通过识别不同环境的共同影响，可以对已识别的因素给予更大的重视。这项研究中只有 12 项研究来自发展中国家，而大多数艾滋病毒/艾滋病患者居住在发展中国家；因此，需要开展更多工作来检查和解决影响世界这些地区抗逆转录病毒治疗依从性的因素。这项研究为研究人员和卫生政策制定者提供了一个可能有助于确保更好地坚持抗逆转录病毒治疗的改变的起点。请通过此摘要的在线版本访问这些网站：http://dx.doi.org/10.1371/journal.pmed.0030438。 Medline Plus 有关艾滋病药物的信息（Medline Plus 是美国国家医学图书馆和美国国立卫生研究院的一项服务） 联合国艾滋病毒/艾滋病联合规划署提供有关全球艾滋病毒/艾滋病流行状况的信息 世界卫生组织有一个艾滋病毒/艾滋病项目网站，提供有关全球艾滋病毒/艾滋病流行情况的全面信息 世界卫生组织有关抗逆转录病毒治疗的页面
Adherence to highly active antiretroviral therapy (HAART) medication is the greatest patient-enabled predictor of treatment success and mortality for those who have access to drugs. We systematically reviewed the literature to determine patient-reported barriers and facilitators to adhering to antiretroviral therapy. We examined both developed and developing nations. We searched the following databases: AMED (inception to June 2005), Campbell Collaboration (inception to June 2005), CinAhl (inception to June 2005), Cochrane Library (inception to June 2005), Embase (inception to June 2005), ERIC (inception to June 2005), MedLine (inception to June 2005), and NHS EED (inception to June 2005). We retrieved studies conducted in both developed and developing nation settings that examined barriers and facilitators addressing adherence. Both qualitative and quantitative studies were included. We independently, in duplicate, extracted data reported in qualitative studies addressing adherence. We then examined all quantitative studies addressing barriers and facilitators noted from the qualitative studies. In order to place the findings of the qualitative studies in a generalizable context, we meta-analyzed the surveys to determine a best estimate of the overall prevalence of issues. We included 37 qualitative studies and 47 studies using a quantitative methodology (surveys). Seventy-two studies (35 qualitative) were conducted in developed nations, while the remaining 12 (two qualitative) were conducted in developing nations. Important barriers reported in both economic settings included fear of disclosure, concomitant substance abuse, forgetfulness, suspicions of treatment, regimens that are too complicated, number of pills required, decreased quality of life, work and family responsibilities, falling asleep, and access to medication. Important facilitators reported by patients in developed nation settings included having a sense of self-worth, seeing positive effects of antiretrovirals, accepting their seropositivity, understanding the need for strict adherence, making use of reminder tools, and having a simple regimen. Among 37 separate meta-analyses examining the generalizability of these findings, we found large heterogeneity. We found that important barriers to adherence are consistent across multiple settings and countries. Research is urgently needed to determine patient-important factors for adherence in developing world settings. Clinicians should use this information to engage in open discussion with patients to promote adherence and identify barriers and facilitators within their own populations. An analysis of qualitative and quantitative studies found consistent barriers to adherence to HIV therapy across multiple settings and countries, ranging from access to medication to problems with complicated regimens. The World Health Organization has estimated that in 2005, about 38 million people worldwide were living with HIV/AIDS; the mortality caused by HIV/AIDS is very high. Antiretroviral drugs are effective at controlling the disease and extending life span. However, it is important for people to stick to the drug regimens exactly in order to keep levels of HIV low, prevent it from becoming resistant to drugs, and stop the illness from progressing. However, many people find it very difficult to take antiretroviral drugs precisely as they should. There is already some evidence from research studies on the reasons why this is the case. There are two different research approaches taken by these studies: “qualitative” methods, which try to find out about attitudes and behaviors using focus groups, interviews, or other techniques; and “quantitative” methods, which try to find out about peoples' opinions and experience using surveys with set questions for the participants to answer, and then count the different responses. The investigators wanted to put together all of the available evidence from published research studies (called doing a “systematic review”) on which factors affected people's adherence to antiretroviral drugs. They wanted to do a systematic review because it is thought to be a very rigorous way of appraising all the available evidence (although there is considerable debate about the value of using such a method to analyze the results of qualitative research). The study team searched biomedical literature databases as well as conference abstracts and research registries using a defined set of search queries. They screened all the scientific papers they found; those reporting results of original research into factors affecting antiretroviral adherence were then analyzed in more detail. 84 relevant studies were identified, of which 37 used “qualitative” methods (focus groups, interviews, open-ended questioning) and 47 used “quantitative” methods (surveys). Most of these studies had been carried out in the developed world. Then, the researchers extracted the factors affecting adherence from the original studies, which could be either “positive” factors (helping adherence) or “negative” ones (making adherence more difficult). They classified the factors into four key themes: “patient related” (e.g., seeing positive results, fear of disclosure, being depressed); “beliefs about medication” (e.g., faith in how well the drugs worked, side effects); “daily schedules” (e.g., using reminder tools, disruptions to routine); and “interpersonal relationships” (e.g., trusting relations with health-care provider; social isolation). Many barriers to adherence were common to both developed and developing settings. Some factors were unique to the studies conducted in the developing world, such as financial constraints and problems with traveling to get access to treatment. Fear of disclosure was an important barrier identified in many of the studies. The researchers combined the results of many different studies and identified factors that help or obstruct adherence to antiretroviral treatment. By identifying influences common to the different settings, greater weight can be placed on the factors that were identified. Only 12 of the studies included in this research were from the developing world, where the majority of HIV/AIDS patients live; hence more work is needed to examine and address the factors influencing antiretroviral adherence in these parts of the world. This study provides researchers and health policy makers with a starting point for changes that might help to ensure greater adherence to antiretroviral treatment. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0030438. Medline Plus information on AIDS medicines (Medline Plus is a service of the US National Library of Medicine and the National Institutes of Health) Joint United Nations Programme on HIV/AIDS has information about the state of the HIV/AIDS epidemic worldwide The World Health Organization has an HIV/AIDS program site providing comprehensive information on the HIV/AIDS epidemic worldwide The World Health Organization pages on antiretroviral therapy
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影响因子：
3.8
作者：
Fassinou, P;Elenga, N;Msellati, P
通讯作者：
Msellati, P
影响因子：
7.2
作者：
Devereaux, PJ;Choi, PTL;Guyatt, GH
通讯作者：
Guyatt, GH
DOI：
10.1080/0954012031000068407
发表时间：
2003-04-01
影响因子：
1.7
作者：
Adam, BD;Maticka-Tyndale, E;Cohen, JJ
通讯作者：
Cohen, JJ
影响因子：
4.9
作者：
Brigido, LFM;Rodrigues, R;Duarte, AJS
通讯作者：
Duarte, AJS
影响因子：
3.8
作者：
Bangsberg, DR;Perry, S;Moss, A
通讯作者：
Moss, A