Impact of food, housing, and transportation insecurity on ART adherence: a hierarchical resources approach.
Impact of food, housing, and transportation insecurity on ART adherence: a hierarchical resources approach.
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DOI：
10.1080/09540121.2016.1258451
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发表时间：
2017-04
期刊：
影响因子：
1.7
通讯作者：
Kalichman SC
中科院分区：
文献类型：
--
作者：
Cornelius T;Jones M;Merly C;Welles B;Kalichman MO;Kalichman SC
抗逆转录病毒疗法（ART）已将艾滋病毒转化为一种可控制的疾病。然而，必须保持高水平的遵守。缺乏获得基本资源（食物、交通、住房）的机会一直与接受不理想的抗逆转录病毒疗法有关。超越这种直接的影响，本研究采取了分层资源的方法，其中访问基本资源对ART依从性的影响是通过人际资源（社会支持，护理服务）和个人资源（自我效能）介导的。参与者是915名居住在佐治亚州亚特兰大市的HIV阳性男性和女性，他们是从社区中心和传染病诊所招募的。参与者回答了基线问卷，并提供了关于ART依从性的前瞻性数据。在一系列嵌套模型中，出现了一种一致的模式，即缺乏获得基本资源的机会对依从性产生间接的负面影响，通过缺乏获得社会支持和服务以及治疗自我效能降低来调节。缺乏交通工具也对遵守有着显著的直接影响。缺乏获得基本资源的机会对坚持抗逆转录病毒疗法产生负面影响。住房不稳定和粮食不安全的影响通过社会支持、获得服务和自我效能得到充分调解，强调这些是干预的重要目标。有针对性的服务支持可能是特别有益的，因为它既可以促进坚持，又可以将客户与其他服务联系起来，以补充食物，住房和交通。无法获得交通工具对依从性有直接的负面影响，这表明免费或降低成本的交通工具可以对弱势群体的抗逆转录病毒治疗依从性产生积极影响。
Antiretroviral therapy (ART) has transformed HIV into a manageable illness. However, high levels of adherence must be maintained. Lack of access to basic resources (food, transportation, housing) has been consistently associated with suboptimal ART adherence. Moving beyond such direct effects, this study takes a hierarchical resources approach in which the effects of access to basic resources on ART adherence are mediated through interpersonal resources (social support, care services) and personal resources (self-efficacy). Participants were 915 HIV-positive men and women living in Atlanta, GA, recruited from community centers and infectious disease clinics. Participants answered baseline questionnaires, and provided prospective data on ART adherence. Across a series of nested models, a consistent pattern emerged whereby lack of access to basic resources had indirect, negative effects on adherence, mediated through both lack of access to social support and services, and through lower treatment self-efficacy. There was also a significant direct effect of lack of access to transportation on adherence. Lack of access to basic resources negatively impacts ART adherence. Effects for housing instability and food insecurity were fully mediated through social support, access to services, and self-efficacy, highlighting these as important targets for intervention. Targeting service supports could be especially beneficial due to the potential to both promote adherence and to link clients with other services to supplement food, housing, and transportation. Inability to access transportation had a direct negative effect on adherence, suggesting that free or reduced cost transportation could positively impact ART adherence among disadvantaged populations.