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首页> 外文期刊>American Journal of Nursing Science >Determinants of Adherence to Antiretroviral Among HIV Positive Adolescents at Comprehensive Care Clinic, Gertrude's Children Hospital, Nairobi, Kenya
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Determinants of Adherence to Antiretroviral Among HIV Positive Adolescents at Comprehensive Care Clinic, Gertrude's Children Hospital, Nairobi, Kenya

机译：肯尼亚内罗毕盖特鲁德儿童医院综合护理诊所对HIV阳性青少年坚持抗逆转录病毒的决定因素

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Antiretroviral drugs (ARVs) requires adherence of more than 95% for adequate viral suppression. The consequences of poor adherence are failure of viral suppression, decrease CD4 cell count, disease progression, drug resistance, risk of transmission of resistance virus and limited future treatment options. Published data on adherence to ARVs in Kenyan adolescents is limited. The purpose of this study was to determine the ARVS adherence level and describe the healthcare system, medication and social environmental factors affecting this adherence among Human Immune-deficiency Virus (HIV) positive adolescents. This was a descriptive cross-sectional study, where 185 patients aged 10-18 years who had been on ARVs for at least two years were systematically and randomly selected. Only 129 respondents who were HIV fully disclosed were interviewed using a structured questionnaire about their experience taking ARVs. Adherence was measured based on a composite score derived from a three questions adherence tool developed by Center for Adherence Support Evaluation (CASE). Data was also collected via Focused Group Discussion, Key Informant Interviews and from records retrieval. Data analysis was done using Epi data software 3.1 with statistical significance set at p<0.05. Overall, 185 patients were selected but 129 disclosed patients were interviewed; 52.7% males and 47.3% females, estimated level of adherence of 67.34% and the main (63.6%) reason for missing therapy was forgetting. Long waiting time in the clinic and stigmatization were other factors found to affect adherence. The CASE Index Tool depicted high reliability with a Cronbach's α=0.696. The results showed a significant positive correlation between CD4 counts and adherence (Rh0=0.255, p=0.003) and a significant inverse correlation between Viral Load levels and Adherence (Rh0= -0.189, p=0.031). Therefore, the 67.34% adherence level to ART reported in this study is below optimum adherence of 95%. This study gives the following recommendations; (a) Policy review on HIV disclosure procedures with training of health workers on it (b) Put fitting strategies to improve patients' ability to impact on forgetfulness (c) Clinic staff to adopt the use of CASE Tool in assessing adolescent's adherence to ARVs.
机译：抗逆转录病毒药物（ARV）要求坚持95％以上才能有效抑制病毒。依从性差的后果是病毒抑制失败，CD4细胞数量减少，疾病进展，耐药性，耐药病毒传播的风险以及未来有限的治疗选择。关于肯尼亚青少年遵守抗逆转录病毒药物的公开数据有限。这项研究的目的是确定ARVS依从性水平，并描述影响人类免疫缺陷病毒（HIV）阳性青少年依从性的医疗保健系统，药物和社会环境因素。这是一项描述性横断面研究，其中有系统地随机选择了185名年龄在10-18岁的患者接受了至少两年的ARVs治疗。使用结构化调查表，只有129名被完全披露了艾滋病毒的受访者接受了关于他们接受抗逆转录病毒药物的经验的采访。依从性是基于由粘附支持中心（CASE）开发的三个问题依从性工具得出的综合评分来衡量的。还通过重点小组讨论，关键信息访问者和记录检索来收集数据。使用Epi数据软件3.1进行数据分析，其统计显着性设置为p <0.05。总体上，选择了185例患者，但对129例已披露的患者进行了访谈。男性为52.7％，女性为47.3％，估计依从性为67.34％，缺少治疗的主要原因（63.6％）被遗忘了。其他长久的诊所等待时间和污名化也是影响依从性的其他因素。 CASE索引工具显示了高可靠性，Cronbachα= 0.696。结果显示CD4计数与依从性之间存在显着的正相关（Rh0 = 0.255，p = 0.003），而病毒载量水平与依从性之间存在显着的负相关（Rh0 = -0.189，p = 0.031）。因此，这项研究中报道的对ART的67.34％依从性水平低于95％的最佳依从性。这项研究提出以下建议; （a）对HIV披露程序进行政策审查并接受卫生工作者的培训（b）制定合适的策略以提高患者影响健忘的能力（c）诊所的工作人员采用CASE工具来评估青少年对ARV的依从性。

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