健康生态学模型视角下贵阳市成人HIV/AIDS患者初始抗病毒治疗脱失影响因素分析  

Factors influencing initial antiretroviral therapy drop-out among HIV-infected adult patients in Guiyang City from the perspective of health ecological model

作　　者：杨小燕 谢小馨 符燕华 甘霖 马淑静 孔令弘 龙海 YANG Xiaoyan;XIE Xiaoxin;FU Yanhua;GAN Lin;MA Shujing;KONG Linghong;LONG Hai(Department of Infection,Guiyang Public Health Clinical Center Guiyang 550004,Guizhou,China;School of Public Health,Guizhou Medical University,Guiyang 550025,Guizhou,China)

机构地区：[1]贵阳市公共卫生救治中心感染科,贵阳550004 [2]贵州医科大学公共卫生与健康学院,贵阳550025

出　　处：《中国艾滋病性病》2024年第11期1123-1129,共7页Chinese Journal of Aids & STD

基　　金：贵州省科技计划项目(黔科合支撑[2021]一般055)。

摘　　要：目的以健康生态学模型为框架基础,分析贵阳市成人HIV/AIDS患者初始cART脱失的原因及影响因素,为进一步制订降低治疗脱失率的防治政策提供依据。方法采用1∶2匹配病例对照研究的方法,筛选出符合纳入排除标准的发生过停药或失访的HIV/AIDS患者作为脱失组,于2022年1-6月期间由门诊个案管理师进行电话随访招募,告知其停止治疗的危害并向患者普及目前治疗相关政策,如慢性病特殊疾病门诊医保报销政策、艾滋病专项经费、中医药治疗项目经费等,告知其到门诊了解具体事宜,由调查人员在其来门诊时在宣教室对其进行问卷调查。对照组则是从2022年7月来门诊随访领药的治疗者中选择符合纳入标准和匹配条件的患者。调查内容包括个人特质层面、行为特征层面、人际网络层面、生活和工作条件层面、环境政策层面及脱失患者脱失的主要原因。结果共调查脱失组138名,对照组276名,模型的多因素分析结果显示,HIV/AIDS患者cART脱失的危险因素有个人特质:最近一次CD4细胞<200 cells/μL(OR=2.44,95%CI:1.06~5.65)、当前cART方案为含PI(OR=3.66,95%CI:1.27~10.54)、出现过药物不良反应(OR=2.39,95%CI:1.25~4.54);行为特征:饮酒(OR=2.43,95%CI:1.15~5.11)、低等水平自我效能感(OR=4.84,95%CI:1.70~13.78);社会网络:告知他人感染情况(OR=2.78,95%CI:1.25~6.20)、低等及中等社会支持水平(OR=4.48,95%CI:1.20~16.74;OR=3.07,95%CI:1.54~6.14);生活和工作条件:平均月收入在1000~1999元及<1000元(OR=4.93,95%CI:1.84~13.21;OR=3.84,95%CI:1.40~10.56)、初中及以下教育程度(OR=4.08,95%CI:2.12~7.84)、去门诊领药总共花费时间(OR=4.65,95%CI:1.66~13.03)。保护因素有个人特质:除汉族及白族外的其他民族(OR=0.30,95%CI:0.09~0.98);政策环境:获得过项目补贴(OR=0.32,95%CI:0.16~0.64)。结论应加强对饮酒、CD4细胞<200 cells/μL、低收入及低教育程度、距离远等重点人群的随访管理,及Objective Based on the framework of the health ecology model,this study aims to analyze the factors contributing to the initial drop-out from combination antiretroviral therapy(cART)among adult HIV/AIDS patients in Guiyang City.The goal is to provide a basis for developing policies aimed at reducing treatment discontinuation rates.Methods A 1∶2 matched case-control study was conducted.Patients with HIV/AIDS who met the inclusion and exclusion criteria and experienced treatment discontinuation or were lost to follow-up were selected as the dropout group.From January to June 2022,case management nurses conducted telephone follow-ups to recruit participants,inform them of the risks of discontinuing treatment,and educate them regarding current treatment policies,including special outpatient reimbursement policies for chronic diseases,special funds for AIDS,and traditional Chinese medicine treatment projects.Participants were invited to visit the outpatient clinic for further details and were surveyed in the health education room during their visit.The control group was selected from patients who were followed up for medication from July 2022 and met the inclusion criteria and matching conditions.The survey covered personal characteristics,behavioral features,social networks,living and working conditions,environmental policy,and the main reasons for discontinuation among those who discontinued treatment.Results In total,138 patients in the dropout group and 276 in the control group were surveyed.Multivariate analysis of the model revealed that risk factors for c ART drop-out included personal characteristics such as most recent CD4 count<200 cells/μL(OR=2.44,95%CI:1.06-5.65),current c ART regimen including protease inhibitors(OR=3.66,95%CI:1.27-10.54),and experiencing of adverse drug reactions(OR=2.39,95%CI:1.25-4.54),behavioral features such as alcohol consumption(OR=2.43,95%CI:1.15-5.11)and low self-efficacy(OR=4.84,95%CI:1.70-13.78),social network characteristics such as disclosure of HIV status to others(OR=2.7

关 键 词：艾滋病病毒 抗病毒治疗 脱失 健康生态学模型 

分 类 号：R373.9[医药卫生—病原生物学] R512.91[医药卫生—基础医学]