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Antiretroviral therapy adherence measurement in non-clinical settings in South India

机译：印度南部非临床环境中的抗逆转录病毒疗法依从性测量

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Optimal adherence to antiretroviral therapy (ART) is key to viral suppression, but may be impeded by psychosocial consequences of HIV-infection such as stigma and depression. Measures of adherence in India have been examined in clinic populations, but little is known about the performance of these measures outside clinical settings. We conducted a cross-sectional study of 151 Tamil-speaking people living with HIV/AIDS (PLHA) in India recruited through HIV support networks and compared single item measures from the Adult AIDS Clinical Trial Group (AACTG) scale, a visual analog scale (VAS), and a question on timing of last missed dose. Depression was measured using the Major Depression Inventory (MDI) and HIV-related stigma was measured using an adaptation of the Berger Stigma Scale. Mean age was 35.6 years (SD +/- 5.9); 55.6% were male; mean MDI score was 11.9 (SD +/- 9.1); and mean stigma score was 67.3 (SD +/- 12.0). Self-reported perfect adherence (no missed doses) was 93.3% using the AACTG item, 87.1% using last missed dose, and 83.8% using the VAS. The measures had moderate agreement with each other (kappa 0.45-0.57). Depression was associated with lower adherence irrespective of adherence measure used, and remained significantly associated in multivariable analyses adjusting for age and marital status. Stigma was not associated with adherence irrespective of the measure used. The VAS captured the greatest number of potentially non-adherent individuals and may be useful for identifying PLHA in need of adherence support. Given the consistent and strong association between poorer adherence and depression, programs that jointly address adherence and mental health for PLHA in India may be more effective than programs targeting only one.
机译：对抗逆转录病毒疗法（ART）的最佳依从性是抑制病毒的关键，但可能会受到艾滋病毒感染的社会心理后果（如柱头和抑郁）的阻碍。已经在临床人群中检查了印度的依从性措施，但是对于这些措施在临床环境之外的表现知之甚少。我们对通过艾滋病毒支持网络招募的印度151名讲泰米尔语的艾滋病毒/艾滋病患者（PLHA）进行了横断面研究，并比较了成人艾滋病临床试验组（AACTG）量表（一种视觉模拟量表， VAS），以及有关上次错过服药时间的问题。使用主要抑郁量表（MDI）来测量抑郁症，并使用Berger耻辱量表对艾滋病相关的污名进行测量。平均年龄为35.6岁（SD +/- 5.9）;男性为55.6％;平均MDI分数为11.9（SD +/- 9.1）;平均柱头得分为67.3（SD +/- 12.0）。自我报告的完美依从性（无遗漏剂量）使用AACTG项目为93.3％，使用上次遗漏剂量为87.1％，使用VAS为83.8％。这些措施彼此之间具有适度的一致性（kappa 0.45-0.57）。抑郁症与较低的依从性相关，而与所使用的依从性衡量方法无关，并且在针对年龄和婚姻状况进行调整的多变量分析中，抑郁症仍与显着相关。不管使用何种方法，柱头都与依从性无关。 VAS捕获了最多数量的潜在非依从性个体，对于识别需要依从性支持的PLHA可能有用。鉴于较差的依从性和抑郁症之间始终存在牢固的联系，在印度，针对PLHA共同解决依从性和心理健康问题的计划可能比仅针对一个的计划更为有效。

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