ABSTRACT

Patient initiated decisions to forgo taking medications (i.e. intentional nonadherence) pose significant challenges to managing chronic health conditions. Identifying factors and their underlying mechanisms that impede medication adherence is essential to designing treatment improvement interventions. This study tested a conceptual model that posits the effects of perceived sensitivity to medicines on adherence can be explained by the experience of side-effects, leading to intentionally nonadherent behaviors. Patients receiving HIV care in the southern United States (N = 209) completed measures of perceived sensitivity to medicines, antiretroviral therapy (ART) side-effects, intentional nonadherence and overall adherence. Patients also provided consent to access their electronic medical records to collect subsequent reports of HIV viral load tests. Results indicated that more than one in four participants were intentionally nonadherent to ART. Mediation modeling showed that perceived sensitivity to medicines was associated with greater experience of ART side-effects and intentional nonadherence, which impacted overall ART adherence and HIV viral load. There were also significant indirect effects of perceived sensitivity to medicines on HIV viral load through side-effects and intentional nonadherence. Patients with increased perceived sensitivity to medicines are at risk for poor treatment outcomes and these negative outcomes are partly explained by experiencing greater side-effects and intentional nonadherence.

摘要

患者主动放弃服药的决定（即故意不依从）对管理慢性健康状况构成重大挑战。识别阻碍药物依从性的因素及其潜在机制对于设计治疗改进干预措施至关重要。本研究测试了一个概念模型，该模型假定对药物的感知敏感性对依从性的影响可以通过副作用的经验来解释，从而导致故意不依从行为。在美国南部接受 HIV 治疗的患者 (N = 209) 完成了对药物感知敏感性、抗逆转录病毒治疗 (ART) 副作用、故意不依从性和总体依从性的测量。患者还同意访问他们的电子病历，以收集随后的 HIV 病毒载量测试报告。结果表明，超过四分之一的参与者故意不遵守 ART。中介模型表明，对药物的感知敏感性与更多的 ART 副作用和故意不依从性相关，这会影响整体 ART 依从性和 HIV 病毒载量。通过副作用和故意不依从性，对药物的感知敏感性对 HIV 病毒载量也有显着的间接影响。对药物感知敏感性增加的患者面临治疗结果不佳的风险，这些负面结果部分可以通过经历更大的副作用和故意不依从来解释。中介模型表明，对药物的感知敏感性与更多的 ART 副作用和故意不依从性相关，这会影响整体 ART 依从性和 HIV 病毒载量。通过副作用和故意不依从性，对药物的感知敏感性对 HIV 病毒载量也有显着的间接影响。对药物感知敏感性增加的患者面临治疗结果不佳的风险，这些负面结果部分可以通过经历更大的副作用和故意不依从来解释。中介模型表明，对药物的感知敏感性与更多的 ART 副作用和故意不依从性相关，这会影响整体 ART 依从性和 HIV 病毒载量。通过副作用和故意不依从性，对药物的感知敏感性对 HIV 病毒载量也有显着的间接影响。对药物感知敏感性增加的患者面临治疗结果不佳的风险，这些负面结果部分可以通过经历更大的副作用和故意不依从来解释。