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首页> 外文期刊>Internal medicine journal >Evidence-based, multifactorial approach to addressing non-adherence to antiretroviral therapy and improving standards of care.
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Evidence-based, multifactorial approach to addressing non-adherence to antiretroviral therapy and improving standards of care.

机译：解决不遵守抗逆转录病毒疗法和改善护理标准的基于证据的多因素方法。

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BACKGROUND: Near-perfect adherence to antiretroviral therapy over time is critical to achieve viral suppression and recovery of functional immunity in individuals infected with HIV. The concept of adherence as a dynamic behaviour influenced by multiple biopsychosocial factors motivated us to implement an integrated, multifactorial programme in our hospital-based setting. The aims of this study were to survey the scope and determinants of non-adherence in patients attending the Ambulatory HIV Service at Royal Perth Hospital, to develop a method for longitudinal monitoring and to implement measures tailored to support individuals. METHODS: The US Adult AIDS Clinical Trials Group self-report baseline adherence, follow-up and side-effect questionnaires were used to survey 247 patients at two time-points between September 2002 and February 2003. A longitudinal monitoring method was developed and the WA HIV Cohort Study database used to collate results with clinical markers up to December 2005. RESULTS: Adherence was associated with viral suppression and CD4 T-cell recovery and improved over the 3-year period under observation (all P < 0.001). Diminishing adherence was associated with younger age (P = 0.002), substance use (P < 0.01), perceived stress (P = 0.04) and indicators of depression (P = 0.03). The analyses showed relationships between personal experience of side-effects and the depression indicator scale in patients on antiretroviral therapy. CONCLUSION: The programme resulted in an improvement in adherence in our cohort even after adjusting for pill burden, dosing frequency and highly active antiretroviral therapy regimen and has enhanced focus on patients vulnerable to non-adherence while supporting those not currently at risk.
机译：背景：随着时间的流逝，对抗逆转录病毒疗法的近乎完美的坚持对于在感染HIV的个体中实现病毒抑制和功能免疫的恢复至关重要。坚持作为受多种生物心理社会因素影响的动态行为的概念促使我们在医院环境中实施综合，多因素计划。这项研究的目的是调查参加皇家珀斯医院门诊艾滋病服务的患者不依从的范围和决定因素，开发一种纵向监测方法，并实施量身定制的支持个人的措施。方法：在2002年9月至2003年2月的两个时间点，使用美国成人艾滋病临床试验小组的自我报告基线依从性，随访和副作用问卷调查了247例患者。开发了一种纵向监测方法，并建立了WA HIV队列研究数据库用于将截至2005年12月的结果与临床指标进行比较。结果：依从性与病毒抑制和CD4 T细胞恢复相关，并且在观察的三年期间有所改善（所有P <0.001）。依从性下降与年龄较小（P = 0.002），药物使用（P <0.01），感觉到的压力（P = 0.04）和抑郁症的指标（P = 0.03）有关。分析显示，在接受抗逆转录病毒治疗的患者中，其个人副作用与抑郁指标之间的关系。结论：即使调整了药丸负担，给药频率和高效抗逆转录病毒治疗方案，该计划也改善了我们队列中的依从性，并更加关注易发生非依从性的患者，同时支持了目前未处于危险中的患者。

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