Treatment Terminationand Adherence Of Patients With HIV/AIDS On ART In Nanjing

BackgroundObjectiveAnalyze the ART adherence and treatment termination of patients with HIV/AIDS in Nanjing. And explore the predictors.MethodsBetween May and June 2014,276 patients on HIV care at the second hospital of Nanjing participated in the cross-sectional study. Data were collected using a self-administered health survey questionnaire assessing HAART adherence and socio-demographic statuses. Descriptive and multivariate statistics were used to examine the effects of the factors on self-reported HAART adherence. Using structural equation model to explore the predictors based on the health belief model of ART adherence. Retrospective cohort analysis is used to analyze the treatment termination of the ART cohort of Nanjing. Kaplan-Meier method is used to draw the cumulative incidence curve of the termination, drug withdrawal and mortality. The COX proportional hazards regression model is used to analyze its influencing factors.ResultsAccording to the Center for Adherence Support Evaluation (CASE) Adherence Index,91.3% of the patients were adherent to antiretroviral therapy. Logistic regression analysis revealed that smoking, progress of the disease and side effects, reminder methods and age were correlated with self-reported HAART adherence. Self-efficiency had a direct effect on ART adherence behavior, and it is the most important determinant of health belief model. Perceived susceptibility, perceived severity, perceived benefits and perceived barriers had indirect associations with ART adherence behavior.976 patients of Nanjing were included to the retrospective cohort analysis, the median of ART follow-up time is 19.93(QR:11.48?34.07) months. The cumulative incidence of termination on 3 months,6 months, I year,2 years,4 years,8 years since the starting of ART was 3.01%,5.17%,7.47%,10.97%,17.45%,28.72%. Age, marriage status, infection routes, the baseline CD4 cell count, the WHOclinicalstage at the end of the observing were correlated with the treatment termination(drug withdrawal and death).ConclusionThere is an elevated risk for non-adherence in smokers, younger, people experiencing side effects, having no reminder methods or having improved clinical status in our sample. Adherence improving initiatives should be tailored to these risk groups. Future ART adherence enhancing interventions should focus on increasing perceived severity, and improving self-efficiency among HIV infections/AIDS patients.In order to reduce terminationamong HIV infections/AIDS patients, efficient interventions targeting younger, divorced/separated/widowed, intravenous drug users, patients with higher CD4 cell count at the beginning of treatment and WHO clinical stage ? or ? at the end of the follow-up should be enhanced.