| Purpose:The purpose of this study was to identify the current situation of comorbidities,polypharmacy,potential drug-drug interactions(PDDIs)and medication-related burden,and perform path analysis among older PLWHIV,and also analyze the relation between medication-related burden and antiretroviral therapy(ART)adherence.Patients and Methods:A cross-sectional study was conducted with185 participants recruited from two HIV clinics in Yuelu District Center for Disease Control(CDC)and Changsha First Hospital in Changsha,Hunan province,China,between December 2020 and February 2021.Participants filled questionnaires about demographic information,comorbidities,polypharmacy,medication-related burden and ART adherence.SPSS 26.0 was used for data processing and analysis in this study.T test,F test,variance analysis,X~2test,Spearman correlation analysis and multiple linear regression analysis were used to analyze the current situation of medication-related burden and its influencing factors,as well as the correlation between medication-related burden and ART adherence.Amos 26.0 was used for path analysis of comorbidities,polypharmacy,medication-related burden and PDDIs.Results:(1)Current situation of comorbidity and polypharmacy:Among the participants,57.3%of patients had at least one comorbidity and about 40%of participants were receiving polypharmacy.(2)Current situation of PDDIs:A total of 45 PDDIs,including 7yellow flags(weak PDDIs),37 amber flags(PDDIs),and 1 red flag(recommended change of medications),were identified among 36participants.The prevalence of PDDIs in participants with polypharmacy(52.8%)was significantly higher than in participants without polypharmacy(6.1%)(X~2=26.580,p<0.001).(3)Current situation and influecing factors of medication-realted burden:The mean score of overall medication-related burden was 104.7.The score of medication-related burden in patients with polypharmacy was 109.8±16.3(moderate degree)significantly(t=-3.678,p<0.001)higher than that of patients without polypharmacy(101.2±14.0)(mild degree).And PLWH,who were female(β=0.157;95%CI=0.849,10.161),had a lower monthly income(β=-0.308;95%CI=-7.161,-2.824),and took more drugs(β=0.232;95%CI=3.171,11.440)were more likely to report a higher level of medication-related burden.(4)Current situation of ART adherence:The average overall score of ART adhercence of 185 patients was 14.8,about 94.6%of older HIV/AIDS patients scored≥11,indicating that most patients had good ART adherence.Spearman correlation analysis suggests that the score of ART adherence was negatively associated with medication-related burden(r_s=-0.250 p=0.001).(5)The results of path analysis and mediating effect test:The mediating effect of polypharmacy between comorbidity and medication-related burden,comorbidity and PDDIs were both significant,accounting for 27.3%and 17.4%.The direct effect of PDDIs on medication-related burden was not statistically significant.Conclusion:(1)The results of our study showed that nearly half of older PLWHIV took polypharmacy,and more than half encountered PDDIs.Clinical nurses should conduct thorough evaluations and be aware of PDDIs.(2)PLWHIV who were female,had a lower income,and took polypharmacy were more likely to report a higher level of medication-related burden,which was significantly associated with poor ART adherence.(3)Polypharmacy partially mediates the relationship between comorbidity and medication-related burden,comorbidity and PDDIs which suggests us that polypharmacy should be emphasized to reducing medication-related burden among aged PLWHIV.Meanwhile clinical nurses should help older PLWHIV to reduce medication-related burden from different domains such as scheduling medications as well as strengthening medication health education to further improve ART adherence.At the same time,we should not ignore the evaluation of patients without polypharmacy,who are also likely to have PDDIs in their medications. |
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