Omar Sued, Violeta J Rodriguez, Stephen M Weiss, Maria Luisa Alcaide, Diego Cecchini, Pedro Cahn, Isabel Cassetti, Chloe J Kaminsky, Deborah L Jones
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引用次数: 0
摘要
背景：尽管阿根廷提供免费的艾滋病护理服务，但坚持治疗和继续接受护理的情况仍不理想。本研究旨在探讨与自我报告的坚持治疗和长期就诊相关的因素：参与者（N = 360）为失去治疗机会的艾滋病病毒感染者（PLWH）（即在过去 6 个月中错过了 3 次药房取药，或在过去 12 个月中没有去看医生）。参与者是从阿根廷四个城市中心的七家艾滋病诊所招募的，并重新接受了护理。在两年的时间里，对人口统计学变量、预测因素（即饮酒、自我效能、动机、患者与医护人员的沟通、保险类型（私人/公共））和结果（即错过传染病（ID）专家预约、错过其他诊所和实验室预约以及自我报告的依从性）进行了评估。在广义线性混合模型框架内使用逻辑回归和泊松回归模型分析预测因素、治疗依从性结果之间的关联以及与时间的交互作用：结果：在重新接受治疗后，饮酒增加与长期坚持抗逆转录病毒治疗的几率降低、错过ID专家预约和错过诊所/实验室预约的几率增加有关。随着时间的推移，自我效能与更好地坚持服药和减少错过 ID 专家预约有关。同样，随着时间的推移，积极性和患者/医疗服务提供者的沟通也与较少错过 ID 专家预约和门诊/实验室预约有关。拥有私人医疗保险也与较少错过门诊/化验室预约有关：研究结果表明，减少酒精使用的干预措施可以改善这一人群的治疗效果。此外，针对患者与医疗服务提供者之间的沟通以及患者的自我效能和动机采取干预措施，可提高患者在重新接受治疗后的保留率。
Antiretroviral Therapy Adherence and Clinic Attendance Over Time Among People in Argentina Living with HIV and Lost to Care.
Background: Although Argentina provides access to no cost HIV care, treatment adherence and retention in care remain suboptimal. This study aimed to explore factors associated with self-reported adherence and appointment attendance over time.
Method: Participants (N = 360) were people living with HIV (PLWH) that were lost to care (i.e., three missed pharmacy pickups in the last 6 months, or had not attended a physician visit in the last 12 months). Participants were recruited from seven HIV clinics in four urban centers in Argentina and re-engaged in care. Demographic variables, predictors, i.e., alcohol use, self-efficacy, motivation, patient-provider communication, insurance type (private/public), and outcomes, i.e., missed infectious disease (ID) specialist appointments, other missed clinic and lab appointments, and self-reported adherence were assessed over 2 years. A logistic regression and Poisson regression model within a generalized linear mixed model framework was used to analyze the association between predictors, treatment adherence outcomes, and interactions with time.
Results: Following re-engagement in care, increased alcohol use was associated with lower odds of antiretroviral therapy adherence over time, increased odds of missing ID specialist appointments, and missed clinic/lab appointments. Self-efficacy was associated with better medication adherence and fewer missed ID specialist appointments over time. Similarly, both motivation and patient/provider communication were associated with fewer missed ID specialist and clinic/lab appointments over time. Having private health insurance was also associated with less missed clinic/lab appointments.
Conclusion: Findings suggest alcohol use reduction interventions could improve treatment outcomes in this population. Additionally, interventions targeting patient-provider communication and patient self-efficacy and motivation may enhance retention following re-engagement in care.
期刊介绍：
The International Journal of Behavioral Medicine (IJBM) is the official scientific journal of the International Society for Behavioral Medicine (ISBM). IJBM seeks to present the best theoretically-driven, evidence-based work in the field of behavioral medicine from around the globe. IJBM embraces multiple theoretical perspectives, research methodologies, groups of interest, and levels of analysis. The journal is interested in research across the broad spectrum of behavioral medicine, including health-behavior relationships, the prevention of illness and the promotion of health, the effects of illness on the self and others, the effectiveness of novel interventions, identification of biobehavioral mechanisms, and the influence of social factors on health. We welcome experimental, non-experimental, quantitative, qualitative, and mixed-methods studies as well as implementation and dissemination research, integrative reviews, and meta-analyses.
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