Nonadherence to Primary Prophylaxis against Pneumocystis jirovecii Pneumonia 英文参考文献.docVIP

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Nonadherence to Primary Prophylaxis against Pneumocystis jirovecii Pneumonia 英文参考文献.doc

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Nonadherence to Primary Prophylaxis against Pneumocystis jirovecii Pneumonia 英文参考文献

NonadherencetoPrimaryProphylaxisagainst PneumocystisjiroveciiPneumonia JamesD.Heffelfinger1*,AndrewC.Voetsch1,GlennV.Nakamura1,PatrickS.Sullivan2,A.D. McNaghten1,LaurenceHuang3 1Division ofHIV/AIDS Prevention,NationalCenter for HIV/AIDS, ViralHepatitis, STDandTBPrevention,Centersfor Disease Control andPrevention, Atlanta,Georgia, UnitedStatesofAmerica,2RollinsSchoolofPublicHealth,EmoryUniversity,Atlanta,Georgia,UnitedStatesofAmerica,3HIV/AIDSDivisionandDivisionofPulmonary andCriticalCareMedicine,UniversityofCaliforniaSanFrancisco,SanFrancisco,California,UnitedStatesofAmerica Abstract Background: Despite the effectiveness of prophylaxis, Pneumocystis jirovecii pneumonia (PCP) continues to be the most commonseriousopportunisticinfectionamongHIV-infectedpersons.Wedescribefactorsassociatedwithnonadherenceto primaryPCPprophylaxis. Methodology/PrincipalFindings:Weused2000–2004datafromtheSupplementtoHIV/AIDSSurveillance(SHAS)project,a cross-sectional interview project of HIV-infected persons $18 years conducted in 18 states. We limited the analysis to personswhodeniedhavingpriorPCP,reportedhavingacurrentprescriptiontopreventPCP,andansweredthequestion ‘‘Inthepast30days,howoftenwereyouabletotakethePCPmedication(s)exactlythewayyourdoctortoldyoutotake them?’’ We used multivariable logistic regression to describe factors associated with nonadherence. Of 1,666 subjects prescribedPCPprophylaxis,305(18.3%)werenonadherent.Personsweremorelikelytobenonadherentiftheyreported using marijuana (adjusted odds ratio [aOR]=1.6, 95% confidence interval [CI]=1.1–2.4), non-injection drugs other than marijuana(aOR=1.5,95%CI=1.0–2.1),orinjectiondrugs(aOR=2.3,95%CI=1.3–4.1)inthepastyear;theirmentalhealth was‘‘notgood’’for$1dayduringthepastmonth(aOR=1.6,95%CI=1.2–2.2);theirmostrecentCD4countwas ,200 cells/mL (aOR=1.6, 95% CI=1.1–2.2); or taking ART usually (aOR=9.6, 95% CI=6.7–13.7) or sometimes/rarely/never (aOR=18.4,95%CI=11.1–30.4),comparedwithalways,asprescribed. Conclusion/Si