Related Research About Antiretroviral Therapy Adherence Among HIV/AIDS Patients In Xi’an Region

AbstractThirty years after the identification of HIV, a cure for HIV infection is still to be achieved. The advent of highly active antiretroviral therapy(HAART) has dramatically improved the survival time and life quality of patients by effectively suppressed the viral replication and slowed down the progress of the disease.Recent years, the research of functional cure of AIDS has rapidly developed, although there were individual case reports of success, but still difficult to actualize in larger scope for short term.With the failure of “Mississippi baby”, we know there is a long road to the cure of AIDS, life-long HAART is still the only treatment for a long time. Steady progress has been made in HIV/AIDS prevention and control in China over the past 10 years. The succss of national scale-up of free ART has dramatically decreased HIV-related morbidity and mortality, transformed the HIV infection from a fatal disease to a more manageable chronic illness. Unlike other chronic diseases, the current regimens are life-long requirement of strict adherence. Poor adherence can lead to treatment failure by insufficient blood drug concentration and virological suppression and the spread of multi-drug resistant forms of the virus, resulting in a public health clalmity. Methods:A cross-sectional methods study was conducted in 2013-2014. The targeted populations of this study were people over 18 years old with correct cognitive-behavior ability and started ART at least for 6 months. They were all voluntary to complete the interview.We conducted the investigation respectively in Tangdu hospital and the eighth hospital in Xi’an. Adherence was assessed by Adult AIDS Clinical Trial Groups(AACTG) adherence instrument adapted with our own cultural. It included the socio-demographic of patients, the currently adherence of ART, knowledge and perception of AIDS, family and social support and other related variables. Adherence was defined as the percentage of the medication they take according to the requirement of doctors. Patients who took their medicine past the schedule dosing time for 2 hours were also defined poor adherence. This is a more standard definition of adherence which includ the dose and time together. Patients were considered 100% adherent when they not missing any dose and not mistiming over 2 hours based on self-report in a four-week recall prior to the study; otherwise, they were categorized as non-adherent. We also collected their CD4 count and HIV viral load. Statistical analyses were conducted using the Statistical Package for the Social Science(SPSS) version 19.0 which processed with the general descriptive analysis, Chi squared test, analysis of variance of repeated measurement data and multiple logistic regressions analysis. The research revealed the current state of adherence among people living with HIV(PLWH), factors associated with adherence and the relationship between adherence and treatment outcomes. Results:1. The general quantitative results and currently states of adherence: In total 535 eligible patients who completed the questionnaire correctly, 384(71.8%) patients belonged to MSM(men who have sex with men). The rate of adherence in our sample was 88.6%. The mainly reasons for missing medicine were forget and busy with other things(72.1%, 44/61), side-effects(47.5%, 29/61), away from home without medicine(19.7%,12/61). Expect patients who missed or mistiming their medicine, there were also 15(2.8%) patients who take the wrong medicine, 6(1.1%) patients who had regimen interrupt.2. Factors associated with ART adherence: Initially, explanatory variables were included in the model one at a time to examine their univariate relationship with adherence. And following on from this univariate analysis, multiple logistic regressions was used to model the effects of many variables simultaneously. Variables were fitted in the model in blocks: religious belief(OR=15.837,P=0.011), frequency of daily doses(OR=3.905 P<0.001), alcohol use(OR=3.058, P=0.007), use of reminder tools(OR=3.012, P=0.001),schedule follow-ups( OR=2.079, P=0.025), the knowledge of adherence related information(OR=1.558 P<0.001). At each stage, the least significant variable was excluded until the model contained only statistically significant factors. Statistical analyses were conducted using the Statistical Package for the Social Science(SPSS) version 19.0 and p-value of less than 0.05 was used to define statistical significance.3. From analysis of variance of repeated measurement data, we found there were statistically significant in CD4 count in different period of treatment between optimal adherence and poor adherence(F=6.639, P=0.01). The occurrence of opportunistic infections were associate with CD4 count(OR=0.163, P<0.001), the virologic suppression(OR=0.306, P=0.018) and adherence(OR=0.369, P=0.017). 31 patients occurred virologic failure during the treatment, length of the treatment(OR=4.068, P=0.002) and adherence(OR=0.080, P<0.001) were associated with HIV virologic response in multivariate analysis. ConclusionThe adherence of ART in Xi’an HIV/AIDS patients were relatively higher among whom 70% were MSM. The establishment of optimal adherence directly affects treatment outcomes. Our research revealed adherence is a dynamic process functioned by various factors like other health behaviors. It included comprehensive factors which were well characterized by the IMB skills model. Barriers to adherence most likely change over time within a given individual and can span across multiple areas at any given point in time. Difficulties with ART adherence of HIV/AIDS patients are not unidimensional by targeting only one aspect of adherence. So in further clinical work, intervening to improve or support adherence will likely be most effective with theory-based intervention targeting potential barriers within each of the information, motivation, and behavioral skills dimensions.