Female gender predicts lower access and adherence to antiretroviral therapy in a setting of free healthcare.
Female gender predicts lower access and adherence to antiretroviral therapy in a setting of free healthcare.
复制标题
DOI：
10.1186/1471-2334-11-86
复制
发表时间：
2011-04-06
影响因子：
3.7
通讯作者：
Wood E
中科院分区：
文献类型：
--
作者：
Tapp C;Milloy MJ;Kerr T;Zhang R;Guillemi S;Hogg RS;Montaner J;Wood E
注射吸毒者(IDU)的艾滋病毒治疗障碍是一个主要的公共卫生问题。然而，仍然很少有长期研究调查可能对抗逆转录病毒治疗(ART)构成障碍的关键人口统计和行为因素--特别是性别差异--特别是在全民医疗的环境中。我们评估了在通过全民医疗系统免费提供医疗和抗逆转录病毒治疗的情况下，HIV阳性注射吸毒者的长期队列中获得抗逆转录病毒治疗的机会和依从性。我们评估了加拿大HIV阳性注射吸毒者的基线抗逆转录病毒使用和随后对抗逆转录病毒疗法的依从性。我们使用广义估计方程Logistic回归来评估与95%的抗逆转录病毒治疗依从性相关的因素，这些因素是基于处方续填依从性估计的。在1996年5月至2008年4月期间，对545名注射吸毒者进行了中位数23.8个月(四分位数范围：8.5-91.6)的跟踪调查，其中341人(63%)为男性，204人(37%)为女性。在基线访谈之前的6个月内，133名男性(39%)和62名女性(30%)接受了抗逆转录病毒治疗(p=0.042)。在对临床特征和纵向测量的药物使用模式进行调整后，女性独立地与95%坚持抗逆转录病毒治疗的可能性降低相关(优势比[OR]=0.70；95%可信区间：0.53-0.93)。尽管普遍可获得免费的艾滋病毒治疗和医疗护理，但女性注射吸毒者不太可能获得和坚持抗逆转录病毒治疗，这一发现与药物使用和临床特征无关。这些数据表明，改善注射吸毒者获得艾滋病毒治疗的干预措施必须量身定做，以解决女性注射吸毒者在抗逆转录病毒治疗方面面临的独特障碍。
Barriers to HIV treatment among injection drug users (IDU) are a major public health concern. However, there remain few long-term studies investigating key demographic and behavioral factors - and gender differences in particular - that may pose barriers to antiretroviral therapy (ART), especially in settings with universal healthcare. We evaluated access and adherence to ART in a long-term cohort of HIV-positive IDU in a setting where medical care and antiretroviral therapy are provided free of charge through a universal healthcare system. We evaluated baseline antiretroviral use and subsequent adherence to ART among a Canadian cohort of HIV-positive IDU. We used generalized estimating equation logistic regression to evaluate factors associated with 95% adherence to antiretroviral therapy estimated based on prescription refill compliance. Between May 1996 and April 2008, 545 IDU participants were followed for a median of 23.8 months (Inter-quartile range: 8.5 - 91.6), among whom 341 (63%) were male and 204 (37%) were female. Within the six-month period prior to the baseline interview, 133 (39%) men and 62 (30%) women were on ART (p = 0.042). After adjusting for clinical characteristics as well as drug use patterns measured longitudinally throughout follow-up, female gender was independently associated with a lower likelihood of being 95% adherent to ART (Odds Ratio [OR] = 0.70; 95% Confidence Interval: 0.53-0.93). Despite universal access to free HIV treatment and medical care, female IDU were less likely to access and adhere to antiretroviral therapy, a finding that was independent of drug use and clinical characteristics. These data suggest that interventions to improve access to HIV treatment among IDU must be tailored to address unique barriers to antiretroviral therapy faced by female IDU.
登录
查看更多内容
DOI：
10.1136/bmj.b1649
发表时间：
2009-04-30
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Wood E;Kerr T;Marshall BD;Li K;Zhang R;Hogg RS;Harrigan PR;Montaner JS
通讯作者：
Montaner JS
DOI：
10.1097/00126334-200107010-00006
发表时间：
2001-07-01
期刊：
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
影响因子：
--
作者：
Lucas, GM;Cheever, LW;Moore, RD
通讯作者：
Moore, RD
DOI：
10.1080/09540120600839280
发表时间：
2006-01-01
影响因子：
1.7
作者：
Krawczyk, Christopher S.;Funkhouser, Ellen;Vermund, Sten H.
通讯作者：
Vermund, Sten H.
影响因子：
5.7
作者：
Berg, KM;Demas, PA;Arnsten, JH
通讯作者：
Arnsten, JH
影响因子：
39.2
作者：
Wood, E;Hogg, RS;Montaner, JSG
通讯作者：
Montaner, JSG