Research On Factors Associated With Adherence Of Highly Active Antiretroviral Therapy Among HIV/AIDS Patients

ObjectiveTo describe adherence prevalence and its influencing factors among HIV-positive patients who received free antiretroviral therapy (ART) for over a year from ART agencies in Yunnan, Sichuan, and Hu’nan, in order to provide some references for enhancing adherence and improving qualities of treatment, as well as minimizing the occurrence of drug resistance in the days to come.MethodsQuantitative and qualitative researches were utilized to study the adherence and the influencing factors among patients in ART agencies.The Quantitative researchThis study selected HIV-positive patients as participants who initiated ART for over a year in Yunnan, Sichuan, and Hu’nan. Information such as demographics, treatment and social support were collected by questionnaires. The adherence was evaluated by tablets of medications that were missed in the past month. Patients who reported total intake of over 95% of the prescribed medication were considered adherent. We analyzed the basic information of the patients after the data import. T-test was made use of analyzing social support, and logistic regression was performed to examine relationships between the adherence and its factors.The Qualitative researchWe conducted in-depth interviews on doctors and patients face to face so as to excavate more information about the patients’adherence, the problem doctor and patient met in the course of treatment, and the maintenance of the patient’s medication compliance. We offered recommendations on how to improve their medication compliance and summarized main points on the basis of the classification of the investigated materials.Results1) 386 patients with medication were investigated.365(94.6%) were of good compliance to the ART while 21(5.44%) were poorly adherent to the medication. The most common reasons for omitting the dose were:forgetting to take tablets (61 cases), being away from home without carrying on the medicine (44 cases), too busy to take medicine on time (13 cases).2) Patients’social support: this study found that patients’social support scores, subjective support scores, objective support scores and utilization scores of social support were lower than the national norm.3) The protective factors(OR<1) influencing the compliance included the correct cognition of medication (OR=0.3195%CI:0.11-0.86) and utilization of social support (OR=0.67 95%CI:0.48-0.94). The self-awareness of regimen complexity (OR=9.34 95%CI:3.25-26.82), taking medicine more than 1 time per day (OR=3.99 95%CI:1.34-11.91), married/cohabitation (OR=4.19 95%CI: 1.48-11.92) and occupation (OR=4.38 95%CI:1.44-13.27) were risk factors(OR>1) of medication adherence.4) Qualitative interviews indicated that doctors used compliance education and peer education to help patients to maintain better adherence. Subjective feelings of the patient did a great favor to the adherence. Most patients hoped that they could obtain more knowledge about the treatment through normal approaches and get better help in the process of taking the medicine.ConclusionThe factors influencing patients’ medication compliance were various. Taking medicine more than 1 time per day, married/cohabitation and agrarian occupation were risk factors of medication adherence. Compared with the above objective factors, subjective factors of the patient were of greater importance. Most patients were deficient in authoritative approaches to acquire knowledge. The broader and deeper compliance education for HIV-positve patients must be required and relevant training towards grassroots health workers should be strengthened. We should set up supporting groups and mobilize social resources simultaneously to help patients to improve and maintain a better compliance.