| ObjectiveTo analyse and investigate the effects and associated factors of antiretroviral therapy among HIV/AIDS patients in an AIDS high prevalence county of LiangShan Yi Autonomous Prefecture(LiangShan Prefecture)and interviews of doctors,in order to know the current effects and problems for improving the qualities of treatment and making decisions.MethodsBoth quantitative and qualitative researches were used to analyze the effect of antiviral therapy and its influencing factors among HIV/AIDS patients in ART of Liangshan Prefecture.The Quantitative researchThis research was select one of AIDS high prevalence county in the middle of LiangShan Prefecture,.The method of convenience sampling was adopted to select the research participants who accepted ART over 6 months,aged 18 years more,and had receivd the HIV testing of viral load in 2016.A retrospective study was used to collect the data with a face-to-face investigation by trained interviewers,including social demography,medicine use,information of medical service acquisition,their own behaviors and cognition.The effect of antiviral therapy was mainly evaluated by virological indicators.The HIV viral suppression was successful when the HIV viral load was detected in 2016 as,400 copies/ml.To analyze the information of the patients after the data imported,combined with the treatment situations in the anti-viral treatment database of the paticipants and the latest HIV viral load by the end of 2016,and describing the relevant information,T-test,?2 test,univariate and multivariate logistic regression were performed to describe paticipants' social support and examine relationships between factors and effects.The Qualitative researchSelected AIDS treatment-related medical staff from county hospital and township hospitals to have personal in-depth interviews,and the results of the interviews were summarized to further understand the local health service delivery,antiviral treatment and related factors that affect antiretroviral therapy effects.ResultsIn this study,395 valid questionnaires were collected,and qualitative research were interviewed 17 medical staff who were mainly responsible for AIDS treatment.The results are as follows:1.General situations:All of the 395 respondents were of Yi minority.The average age of all cases was(39.23 ±7.52)years old and 223 were males(56.5%).The proportion of illiterate participants accounts for 80%(316 cases).Among 395 cases,221 cases' viral load were less than 400 copies,with the effective rate of ART was 55.9%.2.Medication and Health services Access:Among the 395 participants,176(44.6%)reported that they had missed medicines during the therapy.The top three reasons for self-reporting were "forget medication","adverse reactions of medication" and"inconvenience in taking medicine when going out".264(66.8%)of the respondents reported that they had experienced adverse reactions during medication.Among them,91(34.5%)were affect the therapy for adverse reactions.112(28.1%)respondents took the medicine for more than 1 hour from home to the clinic.3.Self-action and Cognition:Among the 395 participants,88 were regular drinkers,accounting for 22.3%,and 102(25.8%)patients still had drug use behavior after starting antiviral treatment.87.3%(345 cases)of patients felt their body got better after taking medications;248 cases(85%)considered that they could not stop taking medicines after they felt better;In response to the question of "whether it can extend their life expectancy by continuing use medicines correctly".only 23%of them believed that it can extend their life expectancy as a common person4.Social support:The rest scores were lower than social norm scores except for the difference between male's social support utilization and social norm score.5.Related factors of antiretroviral therapy:Multivariate analysis showed that HIV/AIDS patients who missed the medication during the antiviral therapy had poor antiviral effects.The OR(95%CI)was 7.06(3.67?13.58).Patients with little adverse reactions that did not affect the therapy and no drug use had better effects.The OR(95%CI)values were 0.45(0.23-0.87)and 0.39(0.16?0.91).Compared to the patients who had a correct cognition that insistting on taking the medicine correctly can extend their life expectancy,the OR(95%CI)values for those who hold the view that could be prolonged by 10-20 years and not/unknown were 4.18(1.59?10.99)and 6.64(2.67-16.53).In addition,the effect of antiviral therapy was better for patients with a higher level of objective support scores and higher total social support.6.The results of qualitative interviews showed that the number of medical staff in the key HIV/AIDS counties in Liangshan Prefecture was insufficiency and their level of education was generally low.The effect of local antiviral therapy was unsatisfactory,mainly due to poor adherence to medications,adverse medicine reactions,and mobile of the population.Compliance education mainly depends on face-to-face education.For mobile population,the overall effect of treatment was relatively poor due to the frequent flow,the unsteady time of going out,and the difficulty in follow-up supervision after the outflow.ConclusionThe effect of HIV/AIDS antiretroviral therapy in key counties of Liangshan Prefecture was not satisfactory,which was related to the education level,whether the medicine was missed during the treatment,whether used drugs and the correct understanding of the treatment.In the process of expanding antiviral treatment,it is necessary to focus on improving compliance and efficiency of therapy.In addition,there were many mobile population in this area and the patients' compliance was poor;The number of medical staff in this erea was insufficiency and the methods of education for patients were single.It is suggested to strengthen the propaganda and education of HIV/AIDS antiviral treatment-related knowledges through multiple channels and methods to improve the compliance of patients with medication.At the same time,strengthen the team and the capacity building of the local medical staff,so as to provide continuous consultation and caring-support services for infected persons. |
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