凉山州成人HIV/AIDS病人退出抗病毒治疗的原因及影响因素

目的了解四川省凉山州成人艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(HIV/AIDS病人)中,已接受抗病毒治疗(ART)的病人退出治疗的原因及影响因素,为今后更好地提高民族欠发达地区ART依从性提供依据和参考。方法选取凉山州HIV/AIDS病人退出治疗较严重的两个县作为研究现场,对符合纳入标准的研究对象采用自行设计的问卷进行调查,采用Logistic回归分析相关影响因素。结果 488名调查对象中,退出ART的病人占37.91%(185人),维持ART的病人占62.09%(303人)。能够维持ART的最主要原因是:认为接受ART后可以延长生命的占68.98%(209/303);退出治疗的主要原因是:外出务工领药不方便占30.27%(56/185),强制戒毒停药17.84%(33/185),药物不良反应12.43%(23/185)和由于农忙等原因未去领药11.35%(21/185)。多因素Logistic回归分析显示,服药后外出务工比值比(OR)3.823,95%可信区间(CI):2.384~6.131]、男性(OR=1.839,95%CI:1.133~2.983)、服用过中药(OR=1.836,95%CI:1.097~3.071)、就医不便捷(OR=1.694,95%CI:1.002~2.866)是退出ART的危险因素;而病人在ART过程中得到家人支持(OR=0.250,95%CI:0.093~0.671)、接受过ART服药依从性教育(OR=0.107,95%CI:0.044~0.260)、ART知识(按得分≥5分计)(OR=0.203,95%CI:0.095~0.434)是HIV/AIDS病人退出ART的保护因素。结论针对HIV/AIDS病人退出ART的问题,可通过完善抗病毒治疗的异地转介机制、推进戒毒所内ART的开展、加强ART人群的依从性教育等措施来改善。

The analysis of reasons and impact factors about withdrawi from antiretroviral therapy among HIV/AIDS patients in Li-angshan autonomous prefecture

Objective To investigate and understand the reasons and impact factors about withdrawl from antiretroviral therapy among HIV/AIDS patients in Liangshan autonomous prefecture, so as to providethe basis and reference for improving adherence of antiretroviral therapy （ART） in minority underdevelopment area. Conclusion Two counties where ART was seriously withdrawn were selected as the study site. Patients who met the inclusion criteria were investigated by a self-designed questionnaire. Logistic regression was used to analyze the correlated impact factors. Results Among the 488 respondents, 185 （37.91%） withdrew from ART, 303（62.09%）maintained ART. The main reason to maintain ART was that AIDS patients thought that ART could prolong their lifetime. The main reason of withdrawl from ART included inconvenience to get ART drugs when they went out for works 30. 27%（56/185）], mandatory detoxification resulting in ART discontinuation 17.83%（33/185）], fear of side effects 12.43% （23/185）] and busy with farm work 11.35% （21/185）]. Multi-factors logistic regression showed the risk factors of withdrawl from ART were going out for works after received ART （OR= 3. 823, 95% CI：2. 384--6.131）, male （OR= 1.839, 950/00 CI：1.133- 2. 983）, taking traditional Chinese medicine （OR 1.836, 95% CI： 1.097--3.071） and inconvenience to seek medical care （OR =1.839, 95% CI= 1.133 2. 983）. The protect factors of withdrawl from ART included getting support from their family members （OR=0. 250, 95% CI： 0. 093-0. 671）, acquiring ed-ucation about the medication adherence （OR=0. 107, 95M CI： 0. 044-0. 260） and having knowledge about ART （equal or greater than 5 scores） （OR=0. 203,95%CI： 0. 095-0. 434）. Conclusions The problem about withdrawl from ART can be improved by consummating the mechanism of ART referral in different regions, providing ART in addiction treatment centre and strengthening education of ART.