Literacy & cognitive skills to understand HIV regimens

为了获得抗逆转录病毒(ARV)治疗的临床好处，HIV+患者必须达到高水平的依从性(90%-95%)。我们对HIV/AIDS患者的研究表明，由于患者不理解他们的剂量说明，可能会出现每日ARV剂量的错误。因此，如果患者在治疗开始时不能理解药物说明，那么就不能期望他们随着时间的推移准确地遵循这些方案。功能性健康素养指的是阅读和理解处方瓶、预约单和其他材料的能力，这些材料确保了患者角色的成功运作(散文素养)。它还包括使用数学技能来计划每天/每周的剂量数量和时间，并预测补充(定量识字)。虽然低散文识字率、年龄和教育与艾滋病毒/艾滋病患者对抗逆转录病毒药物剂量说明的理解不足有关，但在这一人群中，定量识字的作用在很大程度上没有得到研究。此外，众所周知，随着艾滋病毒疾病的进展，认知障碍会发生，执行功能(即解决问题和推理)和学习/记忆方面的缺陷与未能理解抗逆转录病毒治疗方案的指令有关。到目前为止，还没有关于识字对抗逆转录病毒疗法理解的影响的研究解释认知障碍。由于相当大比例的HIV感染患者可能存在认知损害，因此必须考虑这种损害对对ARV药物治疗方案的理解的影响。这项拟议的横断面研究将评估在200名ARV NATve HIV+男性和女性中，低散文素养、低数量素养和特定神经认知能力领域的缺陷与对ARV方案说明的理解不良之间的关系。对ARV方案的初步理解对于继续坚持是必不可少的。确定与抗逆转录病毒药物说明书理解不佳有关的因素是制定干预措施以改善说明书的必要前提。

To derive the clinical benefits of antiretroviral (ARV) therapy, HIV+ patients must attain high levels of adherence (90-95 percent). Our work with HIV/AIDS patients has indicated that errors in daily ARV dosing may occur because patients did not understand their dosing instructions. Therefore, if patients are not able to understand medication instructions at the outset of treatment, then they cannot be expected to accurately follow those regimens over time. Functional health literacy refers to the ability to read and comprehend prescription bottles, appointment slips and other materials that ensure successful functioning in the patient role (prose literacy). It also includes using mathematical skills to plan the number and timing of doses each day/week and to anticipate refills (quantitative literacy). Although low prose literacy, age and education have been associated with poor understanding of ARV dosing instructions in HIV/AIDS patients, the role of quantitative literacy has been largely unstudied in this population. Furthermore, cognitive impairment is known to occur as HIV disease progresses and deficits in executive functions (i.e., problem-solving and reasoning) and learning/memory have been linked to failure to comprehend ARV regimen instructions. No studies on the effects of literacy on ARV regimen comprehension to date have accounted for cognitive impairment. Because a substantial proportion of HIV infected patients are likely to be cognitively impaired, the influence of such impairment on understanding of ARV medication regimens must be considered. The proposed cross-sectional study will assess the relation of low prose literacy, low quantitative literacy and deficits in specific neurocognitive ability domains to poor comprehension of ARV regimen instructions in a mostly ethnic minority sample of 200 ARV naTve HIV+ men and women. Initial comprehension of ARV regimens is essential for continued adherence. Identification of factors related to poor comprehension of ARV medication instructions is a necessary prerequisite for developing interventions to improve it.