Factors influencing initial antiretroviral therapy drop-out among HIV-infected adult patients in Guiyang City from the perspective of health ecological model
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 cART drop-out included personal characteristics such as most recent CD4 count＜200 cells/μL(OR=2.44,95％CI:1.06-5.65),current cART 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=2.78,95％CI:1.25-6.20)and low to moderate social support levels(OR=4.48,95％CI:1.20-16.74;OR=3.07,95％CI:1.54-6.14),living and working conditions such as average monthly income of 1 000-1 999 RMB and less than 1 000 RMB(OR=4.93,95％CI:1.84-13.21;OR=3.84,95％CI:1.40-10.56),education level of junior high school or below(OR=4.08,95％CI:2.12-7.84),and total time spent visiting the clinic for medication(OR=4.65,95％CI:1.66-13.03).Protective factors included personal characteristics such as ethnic groups other than Han and Bai(OR=0.30,95％CI:0.09-0.98)and policy environment parameters such as receipt of project subsidies(OR=0.32,95％CI:0.16-0.64).Conclusions Follow-up management should be strengthened for key populations such as those who consume alcohol,possess CD4 counts＜200 cells/μL,low income,and low education levels,and live far from medical facilities.Targeted prevention and treatment measures should be implemented in a timely manner to enhance medication adherence and reduce post-treatment discontinuation,thereby improving the effectiveness of antiretroviral therapy.
HIV/AIDScombination antiretroviral therapy(cART)dropoutecological health model
万方数据
维普
