Factors Influencing Adherence to Antiretroviral Treatment in Nepal A Mixed-Methods Study 英文参考文献.docVIP

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Factors Influencing Adherence to Antiretroviral Treatment in Nepal A Mixed-Methods Study 英文参考文献.doc

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Factors Influencing Adherence to Antiretroviral Treatment in Nepal A Mixed-Methods Study 英文参考文献

FactorsInfluencingAdherencetoAntiretroviral TreatmentinNepal:AMixed-MethodsStudy SharadaP.Wasti1*,PadamSimkhada1,JulianRandall2,JenniferV.Freeman1,EdwinvanTeijlingen3 1School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom, 2Business School, University of Aberdeen, Aberdeen, United Kingdom,3HealthandSocialCare,BournemouthUniversity,Bournemouth,UnitedKingdom Abstract Background: Antiretroviral therapy(ART) is alifesaver forindividualpatients treated for HumanImmunodeficiency Virus (HIV)andAcquiredImmuneDeficiencySyndrome(AIDS).Maintainingoptimaladherencetoantiretroviraldrugsisessential forHIVinfectionmanagement.ThisstudyaimedtounderstandthefactorsinfluencingadherenceamongstART-prescribed patientsandcareprovidersinNepal. Methods:Across-sectionalmixed-methodsstudysurveying330ART-prescribedpatientsand34in-depthinterviewswith three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factorsassociatedwithadherence,supplementedwithathematicanalysisoftheinterviewtranscripts. Results:Atotalof282(85.5%)respondentsreportedcompleteadherence,i.e.nomisseddosesinthefour-weekspriorto interview. Major factors influencing adherence were: non-disclosure of HIV status (OR=17.99, p= 0.014); alcohol use (OR=12.89, p=,0.001), being female (OR=6.91, p=0.001), being illiterate (OR=4.58, p=0.015), side-effects (OR=6.04, p=0.025),ARTstarted#24months(OR=3.18,p=0.009),traveltimetohospital.1hour(OR=2.84,p=0.035).Similarly, lackofknowledgeandnegativeperceptiontowardsARTmedicationsalsosignificantlyaffectednon-adherence.Transport costs(forrepeatprescription),followedbypillsrunningout,notwantingotherstonotice,side-effects,andbeingbusywere the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination,ART-associa