宁波市HIV/AIDS病人的抗病毒治疗依从性及影响因素

Factors associated with adherence to ART for HIV/AIDS patients in Ningbo

目的了解宁波市艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)抗病毒治疗(ART)依从性情况,进一步分析抗病毒治疗病人服药依从性的影响因素,为制定提高病人依从性的政策和方法提供参考依据。方法随机抽样调查宁波市2004-2015年开始接受ART的HIV/AIDS病人,对一般情况和服药情况进行统计描述,卡方单因素分析和Logistic多因素回归分析ART者依从性的影响因素。依从性评价采用依从性支持评价中心(CASE)指数为判断标准。结果共调查ART的HIV/AIDS病人207例,依从性良好的182例,占87.9%。停服和漏服药物的主要原因是遗忘,占48.4%。最显著的不良反应是服药后引起的恶心、呕吐、皮疹等不适,占45.5%。Logistic多因素分析显示,受调查者知识1(如果服药出现不良反应,可否自己停药或少吃些药)知晓情况差,是影响ART依从性的危险因素[调整比值比(aOR)=8.24,95%可信区间(CI):2.0~33.90,P=0.003]。受调查者知识2(如果不能坚持按时遵医嘱服药,是否可能会导致治疗失败)知晓情况好,是影响ART依从性的保护因素(aOR=0.26,95%CI:0.07~0.97,P=0.044);服药采用提醒方法,是影响ART依从性的保护因素(aOR=0.26,95%CI:0.07~0.90,P=0.034)。结论宁波市HIV/AIDS病人ART依从性整体良好,针对影响ART依从性的原因,加强服药依从性相关知识的宣传教育,倡导患者使用多种服药提醒方法,是提高患者服药依从性的积极有效的应对措施。

Objective To learn the compliance of antiretroviral therapy （ART） for HIV/AIDS patients more than 15 years old and impact factors in Ningbo city. Methods A cross-sectional study was conducted among adult HIV/AIDS patients （≥15 years） diagnosed between 2004 and 2015 with random sampling. Self-administrated ques tionnaire was used to collect data about treatment adherence, side effects, social-demographic characteristic etc. Chisquare test and multivariate logistic regression were used to analyze impact factors associated with adherence. CASE （the Center for Adherence Support Evaluation） adherence index was used to measure adherence to antiretroviral therapy. Results of 207 cases who completed the questionnaire, 182 （87.9%） showed good adherence （case index 〉10）. The main reason for stopping or missing drugs was forgetting （48.4%）. Most of side effects were queasiness, vomiting and rash （45.5 %）. Awareness of knowledge about persisting treatment according to doctor＇s advice was a protective factor to drug adherence （aOR=0.26, 95% CI： O. 07-0.97, P=0. 044）,while discontinuation of ART when side effects occurred was proved to be a risk factor to drug adherence （aOR=8.24,95% CI：2.0-33.90, P=0.003）. The use of reminders was helpful to improve patients＇ adherence （aOR=0.26, 95% CI： 0.07-0.90, P =0. 034）. Conclusion The ART compliance of HIV/AIDS patients in Ningbo is good. The education about compliance and use of reminders to take drug may be the effective way to improve drug adherence.