| Objectives To investigate the status of adherence to highly antiretroviral therapy(HAART) among HIV-infected drug users(IDUs), to explore the factors related to HAART adherence; To examine the effects of comprehensive family intervention on HAART adherence and treatment outcomes among HIV-infected IDUs.Methods This study was an experimental study. One hundred and sixteen IDUs in 3 HAART treatment sites in Hunan Province were selected by random cluster sampling and were randomly divided into two groups, 58 in the intervention group and 58 in the control group. Subjects in the intervention group were given an 9-month comprehensive family intervention, including intervention on individual factors, environment factors and behaviours of individual, while those in the control group received standard treatment and care. When the study was completed, there were 98 valid cases (50 in intervention group and 48 in control group). To analyze the effects of comprehensive family intervention, data of adherence and treatment outcomes (quality of life, CD4~+ T lymphocyte counts, and medical cost) were obtained before the experimentation. Adherence was obtained by using CPCRA questionnaires and the methods of counting pills, and quality of life was measured with Chinese simplified questionnaire of WHO Quality of life (WHOQOL-BREF). The data of CD4~+ T lymphocyte counts were obtained from the medicl records and medical expense in the past three months was assessed through directly asking the patients.Results 1. Based on the amount of medications taken in the past 7 days, the baseline results showed that the average adherent level was 87.77%. Logistic regression analysis indicated that the side effects of HAART, course of disease, housing conditions, living alone and medication konwledge were the independent influencial factors of HAART adherence.2. By Wilcoxon Mann-Whitney U test, Before the intervention, the adherence to dose were not significantly different (P> 0.05) between the intervention group and control group. After the intervention, the amount of HIV-infected IDUs whose adherence to HAART were 100% increased from 31 to 47, the amount of HIV-infected IDUs whose adherence to HAART were 80-99% dropped from 6 to 2, and the amount of HIV-infected IDUs whose adherence to HAART were 0-79% decreased from 11 to 1 the intervention group. There was significantly difference before and after the intervention in the intervention group (Z =- 3.78, P = 0.001), while there was no significant difference before and after the intervention in the control group.The adherence to dose of intervention group is better than the control group after the intervention(Z =- 3.71, P = 0.001).3. By Wilcoxon Mann-Whitney U test: Before the intervention, the adherence to schedule were not significantly different (P> 0.05) between the intervention group and control group. After the intervention, the amount of HIV-infected IDUs who all the time take HAART pills on time increased from 13 to 35, who most of time take HAART pills on time dropped from 31 to 14, and who never or just little time take HAART pills on time decreased from 11 to 1 in the intervention group. There was significantly deference before and after the intervention in the intervention group (Z =- 3.78, P = 0.001), while there was no significant difference before and after the intervention in the control group.The time adherence of intervention group is better than the control group after the intervention (Z =- 3.71, P = 0.001).4. Repeated measures ananlysis of variance showed that the main effects of intervention on domians of physical, psychological, social relations and enviroments of quality of life was significant (P<0. 05), in other word, scores of physical, psychological, social relations and enviroments of quality of life were significantly different with the change of the intervention level without taking account the change of time. The main effects of time on domians of psychological, social relations and enviroments of quality of life were significant (P<0.05), in domain of physical is not significant(P> 0.05). There were significant interactions between time and intervention on the four domains of quality of life. Interation diagram indicated that the improvement degree of four domains of quality of life were higher in intervention group than that of control group over time in the 9-month interventon.5. By Wilcoxon Mann-Whitney U test: The CD4~+T lymphocyte counts was not significantly different (P> 0.05) between the intervention group and control group Before and after the intervention (P>0.05) , there was significantly difference in CD4~+T lymphocyte counts in the intervention group before and after intervention (Z=4.56, P=0.001) , The growth rates of CD4T lymphocyte counts were significantly different between the intervention group and control group (Z=-3.65, P=0.001) .6. Wilcoxon Mann-Whitney U test showed that medical expense were not significantly different between the intervention group and control group both before and after the intervention (P> 0.05).Conclusion 1. The average level of adherence to HAART among HIV-infected IDUs was relatively low, and side effects of HAART, course of disease, housing conditions, living alone and medication konwledge were significantly related to adherence.2. The family interventon enhanced the time and quantity adherence to HAART among HIV-infected IDUs.3. The family interventon improved the domians of physical, psychological, social relations and enviroments of quality of life. The family intervention also enhanced the growth rates of CD4~+T lymphocyte counts. But the effect of family intervention on medical expenses is not significant.
|
PDF Full Text Request