中国三省386例HIV感染者和艾滋病患者抗病毒治疗服药依从性及其影响因素分析

Factors associated with adherence of highly active antiretroviral therapy among 386 HIV/AIDS patients in 3 provinces of China

目的 分析中国3个省接受艾滋病抗病毒治疗者的服药依从性和及时性，以及服药依从性的相关因素。方法 于2014年4—9月，选取云南、四川、湖南省的HIV感染者和艾滋病患者抗病毒治疗定点机构中，坚持抗病毒治疗时间超过1年、既往没有接受过抗病毒治疗且年龄在18岁以上的HIV感染者和艾滋病患者为调查对象，共386例。采用问卷调查其基本情况和抗病毒治疗情况，并采用《社会支持评定量表》计算客观支持、主观支持和对支持的利用维度得分。采用χ2检验对调查对象服药依从性进行单因素分析，采用多因素二分类非条件logictic回归模型分析调查对象服药依从性的相关因素。结果 386例调查对象中，服药依从性好的为365例（94.6%），依从性差者为21例（5.4%）；服药及时的调查对象为357例（92.5%），超过规定时间2 h以上服药者为29例（7.5%）；社会支持总得分为（27.2±7.3）分，其中客观支持得分为（5.6±2.7）分，主观支持得分（16.1±4.8）分，支持利用度得分为（5.5±1.9）分。多因素分析显示，正确认知、自认服药不复杂、每天服药1次或支持利用维度得分较高者服药依从性较好，其OR （95%CI）值分别为3.24（1.17~9.00）、9.34 （3.27~26.68）、4.00（1.35~11.84）和1.49 （1.06~2.01）；已婚／同居者或农民服药依从性较差，其OR （95%CI）值分别为0.24 （0.08~0.67）、0.23（0.08~0.69）。结论 3个省接受抗病毒治疗的HIV感染者和艾滋病患者服药依从性较好，及时性较高，社会支持各维度得分低于常模；正确认知、自认服药不复杂、每天服药1次或支持利用维度得分较高者服药依从性较好。

Objective To investigate adherence and the influence factors among patients who are on antiretrovirus therapy （ART） of 3 provinces in China.Methods This study selected 18-year-old and older AIDS patients as the survey objects who initiated anti-retrovirus therapy between April and September of 2014 and kept on the treatment for one year in Yunnan,Sichuan,and Hu＇nan province. Information of demography, treatment and social support was collected by questionnaires. Adopt SSRS questionnaire to calculate the information of objective support, subjective support and utilization of social support. χ2 test and logistic regression were performed to examine relationships between factors and adherence.Results A total of 386 patients with medication were investigated. Among them, there were 365 （94.6%） cases who were compliant to the ART, and 357 （92.5%） cases can take their pills on time, and 29 （7.5%） cases take their medication in excess of the prescribed time more than two hours. Social support score was 27.2 ± 7.3, including objective support score （5.6 ± 2.7）, subjective support score （16.1 ± 4.8）, and utilization of social support （5.5 ± 1.9）. Multivariate logistic regression analysis revealed that adherence was significantly associated with the correct cognition of medication （OR （95%CI）： 3.24 （1.17-9.00））, the self-awareness of the drug regimen was not complexity （OR （95%CI）： 9.34 （3.27-26.68））, taking medication 1 time a day （OR （95%CI）： 4.00 （1.35-11.84））, and the batter utilization of social support （OR （95%CI）： 1.49 （1.06-2.01））. Married/cohabiting or farmers tend to be nonadherenced, while the OR （95%CI） was 0.24 （0.08-0.67） and 0.23 （0.08-0.69）, respectively.Conclusion The patients among these provinces were compliant to the ART, and most of them can take their pills on time. The social support score of these patients was lower than normal person. Participants who have correct cognition of medication, thinking their drug regimen was not complexity; Taking medication 1 time a day or have high level of utilization of social support showed a significantly higher level of self-reported adherence.